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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1811205131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FACULTY PHYSICIANS AND SURGEONS OF LLUSM

Provider Business Mailing Address
First Line	:	2140 GRAND AVE
Second Line	:	STE 120
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-6800
Country	:	US
Telephone Number	:	909-558-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 GRAND AVE
Second Line	:	STE 120
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-6800
Country	:	US
Telephone Number	:	909-558-3111
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICARDO PEVERINI
Credential	:	M.D.
Telephone Number	:	909-558-3829

Provider Enumeration Date	:	09/21/2010
Last Update Date	:	09/21/2010

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