Faculty Physicians And Surgeons Of Llusm
Dermatology in Loma Linda, CA. Organization (NPI-2).
NPI number1700214780
StatusActive
Last updated in NPPESMay 5, 2020
Details
- NPI
- 1700214780
- Entity type
- Organization (NPI-2)
- Legal business name
- Faculty Physicians And Surgeons Of Llusm
- Organization subpart
- No
- Enumeration date
- Oct 29, 2013
- Certification date
- May 5, 2020
- Last updated
- May 5, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | – | – | Yes |
| 204F00000X | Transplant Surgery | – | – | |
| 363A00000X | Physician Assistant | – | – | |
| 363AS0400X | Physician Assistant, Surgical | – | – | |
| 363L00000X | Nurse Practitioner | – | – |
Practice location
25865 Barton RdLoma Linda, CA 92354-3895
Phone 909-558-3636
Mailing address
File # 54701Los Angeles, CA 90074-4701
Phone 909-558-4000
Authorized official
Ricardo Peverini
President
9095587448
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