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General NPI Number Information
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NPI Number | 1558788331
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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 | 03/18/2014
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 26520 CACTUS AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92555-3927
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Country | US
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Telephone | 951-486-4000
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Fax |
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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 | 909-651-4300
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Fax | 909-651-4586
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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 | 207L00000X
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Taxonomy Name | Anesthesiology 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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease 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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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