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General NPI Number Information
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NPI Number | 1306372073
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Entity Type | Organization
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Legal Business Name | FACULTY PHYSICIANS AND SURGEONS OF LLUSM
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 24785 STEWART ST STE 111
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City | LOMA LINDA
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State | CA
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Zip | 92350-1721
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Country | US
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Telephone | 909-558-8459
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Fax | 909-651-4586
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Provider Business Mailing Address
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Address Line | FILE # 54701
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City | LOS ANGELES
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State | CA
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Zip | 90074-4701
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Country | US
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Telephone | 909-558-4000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICARDO PEVERINI
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Credential | MD
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Telephone | 909-558-7448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083T0002X
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Taxonomy Name | Medical Toxicology (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2083C0008X
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Taxonomy Name | Clinical Informatics Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2083S0010X
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Taxonomy Name | Sports Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number |
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License Number State |
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