| Faculty Physicians And Surgeons Of Llusm | |
|
11130 Anderson St Suite 117 Loma Linda CA 92354-2802 | |
| (909) 558-8576 | |
| (909) 558-3905 |
| Full Name | Faculty Physicians And Surgeons Of Llusm |
|---|---|
| Speciality | Psychologist |
| Location | 11130 Anderson St, 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 11130 Anderson St Suite 117 Loma Linda CA 92354-2802 Ph: (909) 558-8576 |
| NPI Number | 1487603924 |
|---|---|
| Provider Enumeration Date | 05/10/2006 |
| Last Update Date | 07/19/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487603924 | NPI | - | NPPES |
| GPS000762 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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