Healthcare Provider Details

I. General information

NPI: 1811205131
Provider Name (Legal Business Name): FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 GRAND AVE STE 120
CHINO HILLS CA
91709-6800
US

IV. Provider business mailing address

2140 GRAND AVE STE 120
CHINO HILLS CA
91709-6800
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-3111
  • Fax:
Mailing address:
  • Phone: 909-558-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICARDO PEVERINI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-558-3829