| Faculty Physicians And Surgeons Of Llusm | |
|
1686 Barton Rd Redlands CA 92373-7761 | |
| (909) 558-4505 | |
| Not Available |
| Full Name | Faculty Physicians And Surgeons Of Llusm |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 1686 Barton Rd, Redlands, 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 1686 Barton Rd Redlands CA 92373-7761 Ph: (909) 558-4505 |
| NPI Number | 1558311373 |
|---|---|
| Provider Enumeration Date | 05/11/2006 |
| Last Update Date | 07/19/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558311373 | NPI | - | NPPES |
| GR0069028 | Medicaid | CA | |
| GPS000760 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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