Faculty Physicians And Surgeons Of Llusm
Pediatrics in San Bernardino, CA. Organization (NPI-2).
NPI number1124077516
StatusActive
Last updated in NPPESJul 19, 2019
Details
- NPI
- 1124077516
- Entity type
- Organization (NPI-2)
- Legal business name
- Faculty Physicians And Surgeons Of Llusm
- Organization subpart
- No
- Enumeration date
- May 10, 2006
- Last updated
- Jul 19, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208000000X | Pediatrics | – | – | Yes |
Practice location
250 E Caroline St Ste JSan Bernardino, CA 92408-3758
Phone 909-651-1900
Mailing address
File Number 54701Los Angeles, CA 90074-0001
Phone 909-558-3111
Authorized official
Ricardo Peverini
President
9095587448
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