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NPI Code Detail

MEDICARE: FACULTY PHYSICIANS AND SURGEONS OF LLUSM

MEDICARE: FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356391460
Entity Type Code : Organization
Provider Name (Legal Business Name) : FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Provider Business Mailing Address
First Line : FILE NUMBER 54701
Second Line :
City : LOS ANGELES
State : CA
Zip : 90074-0001
Country : US
Telephone Number : 909-558-3111
Fax Number :
Provider Business Practice Location Address
First Line : 6109 W RAMSEY ST
Second Line :
City : BANNING
State : CA
Zip : 92220-3051
Country : US
Telephone Number : 909-558-2848
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : RICARDO PEVERINI
Credential : M.D.
Telephone Number : 909-558-7448
Provider Enumeration Date : 05/11/2006
Last Update Date : 09/22/2025

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Directions to “FACULTY PHYSICIANS AND SURGEONS OF LLUSM ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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