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General NPI Number Information
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NPI Number | 1568113827
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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 | 01/18/2022
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 8599 HAVEN AVE STE 102&210
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4849
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Country | US
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Telephone | 909-558-2806
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Fax |
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Provider Business Mailing Address
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Address Line | FILE NUMBER 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 | 909-651-4352
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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 | 909-651-5582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology 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 | 207RA0001X
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Taxonomy Name | Advanced Heart Failure and Transplant Cardiology 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 | 207RA0002X
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Taxonomy Name | Adult Congenital Heart Disease 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 | 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 #5
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology 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 | 207VC0200X
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Taxonomy Name | Critical Care Medicine (Obstetrics & Gynecology) 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 | 207VG0400X
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Taxonomy Name | Gynecology 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 | 207VM0101X
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Taxonomy Name | Maternal & Fetal 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 | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #14
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #15
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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