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1235189275 NPI number — FACULTY PHYSICIANS AND SURGEONS OF LLUSM

NPI Number: 1235189275
Health Care Provider/Practitioner: FACULTY PHYSICIANS AND SURGEONS OF LLUSM

Information about “1235189275” NPI (FACULTY PHYSICIANS AND SURGEONS OF LLUSM) exists in 1235189275 in HTML format HTML  |  1235189275 in plain Text format TXT  |  1235189275 in PDF (Portable Document Format) PDF  |  1235189275 in an XML format XML  formats.

NPI Number : 1235189275 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1235189275",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FACULTY PHYSICIANS AND SURGEONS OF LLUSM",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "FILE NUMBER 54701",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOS ANGELES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90074-0001",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-558-3111",
    "MailingAddressFaxNumber": "909-558-3950",
    "FirstLinePracticeLocationAddress": "11370 ANDERSON STREET",
    "SecondLinePracticeLocationAddress": "SUITE 3900",
    "PracticeLocationAddressCityName": "LOMA LINDA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92354",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-558-2806",
    "PracticeLocationAddressFaxNumber": "909-558-3905",
    "EnumerationDate": "05/11/2006",
    "LastUpdateDate": "09/22/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PEVERINI",
    "AuthorizedOfficialFirstName": "RICARDO",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "909-558-7448",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207VM0101X",
          "TaxonomyName": "Maternal & Fetal Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207V00000X",
          "TaxonomyName": "Obstetrics & Gynecology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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