| Faculty Physicians And Surgeons Of Llusm | |
|
25845 Barton Road, Ste. F Loma Linda CA 92354-3857 | |
| (909) 558-2828 | |
| Not Available |
| Full Name | Faculty Physicians And Surgeons Of Llusm |
|---|---|
| Speciality | Pediatrics |
| Location | 25845 Barton Road, Ste. F, Loma Linda, California |
| Authorized Official Name and Position | Ricardo Peverini (PRESIDENT) |
| Authorized Official Contact | 9095587448 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Faculty Physicians And Surgeons Of Llusm File Number 54701 Los Angeles CA 90074-0001 Ph: (909) 558-3111 | Faculty Physicians And Surgeons Of Llusm 25845 Barton Road, Ste. F Loma Linda CA 92354-3857 Ph: (909) 558-2828 |
| NPI Number | 1275583007 |
|---|---|
| Provider Enumeration Date | 05/11/2006 |
| Last Update Date | 05/20/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275583007 | NPI | - | NPPES |
| GPS000761 | Medicaid | CA | |
| GR0069729 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
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