Organization
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO PEVERINI M.D. (PRESIDENT)
(909) 558-7448
Entity
Organization
Contact information
Practice address
2195 CLUB CENTER DR, SUITE A-L, SAN BERNARDINO, CA 92408-4170
(909) 558-2154
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-0001
(909) 558-3111
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0069027
—
CA
05
—
GR006902V
—
CA
Enumeration date
05/11/2006
Last updated
02/02/2023
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