Organization
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO PEVERINI MD (PRESIDENT)
(909) 651-5582
Entity
Organization
Contact information
Practice address
11374 MT VIEW AVE STE A, LOMA LINDA, CA 92354-3816
(909) 558-6715
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-4701
(909) 651-4352
(909) 651-4586
Taxonomy
Speciality
Code
Description
License number
State
103TF0200X
Forensic Psychologist
—
—
208000000X
Pediatrics Physician
Primary
—
—
2080C0008X
Child Abuse Pediatrics Physician
—
—
2080T0002X
Pediatric Medical Toxicology Physician
—
—
2084F0202X
Forensic Psychiatry Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Enumeration date
12/03/2021
Last updated
12/03/2021
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