MEDICARE: FACULTY PHYSICIANS AND SURGEONS OF LLUSM

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2471R0002X	Radiation Therapy Radiologic Technologist
2	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist
3	2085B0100X	Body Imaging Physician
4	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician
5	2085H0002X	Hospice and Palliative Medicine (Radiology) Physician
6	2085N0700X	Neuroradiology Physician
7	2085N0904X	Nuclear Radiology Physician
8	2085P0229X	Pediatric Radiology Physician
9	2085R0202X	Diagnostic Radiology Physician
10	2085R0203X	Therapeutic Radiology Physician
11	2085R0204X	Vascular & Interventional Radiology Physician
12	2085R0205X	Radiological Physics Physician
13	2085U0001X	Diagnostic Ultrasound Physician
14	2471C3402X	Radiography Radiologic Technologist
15	2085R0001X	Radiation Oncology Physician

NPI Number	:	1588273148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FACULTY PHYSICIANS AND SURGEONS OF LLUSM

Provider Business Mailing Address
First Line	:	FILE NUMBER 54701
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-4701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	399 E 21ST ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4815
Country	:	US
Telephone Number	:	909-558-3012
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICARDO PEVERINI
Credential	:	MD
Telephone Number	:	909-651-5582

Provider Enumeration Date	:	07/29/2020
Last Update Date	:	07/29/2020

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

399 E 21ST ST
SAN BERNARDINO, CA
92404-4815