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General NPI Number Information
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NPI Number | 1790735009
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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 | 05/10/2006
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 27990 SHERMAN RD
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City | SUN CITY
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State | CA
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Zip | 92585-9155
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Country | US
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Telephone | 951-672-1931
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Fax | 909-558-3905
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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 | 90074-0001
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Country | US
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Telephone | 909-558-3111
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Fax | 909-558-3905
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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 | M.D.
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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