Provider Demographics
NPI:1316599640
Name:FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Entity Type:Organization
Organization Name:FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEVERINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-651-5582
Mailing Address - Street 1:FILE NUMBER 54701
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-4701
Mailing Address - Country:US
Mailing Address - Phone:909-651-4352
Mailing Address - Fax:909-651-4586
Practice Address - Street 1:1801 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2607
Practice Address - Country:US
Practice Address - Phone:909-558-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant SurgeryGroup - Multi-Specialty
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant HepatologyGroup - Multi-Specialty
No2080T0004XAllopathic & Osteopathic PhysiciansPediatricsPediatric Transplant HepatologyGroup - Multi-Specialty