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
1	103G00000X	Clinical Neuropsychologist

Other Identifiers

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

General Provider Information

NPI Number	:	1619927647
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	:	909-558-3905

Provider Business Practice Location Address
First Line	:	11406 LOMA LINDA DR
Second Line	:	SUITE 300
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3711
Country	:	US
Telephone Number	:	909-558-6144
Fax Number	:	909-558-3905

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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