Organization · NPI-2

Faculty Physicians And Surgeons Of Llusm

Pediatrics · Loma Linda, CA

NPI number1992463251

StatusActive

Last updated in NPPESDec 3, 2021

Details

NPI: 1992463251
Entity type: Organization (NPI-2)
Legal business name: Faculty Physicians And Surgeons Of Llusm
Organization subpart: No
Enumeration date: Dec 3, 2021
Certification date: Nov 23, 2021
Last updated: Dec 3, 2021

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
208000000X	Pediatrics	–	–	Yes
103TF0200X	Psychologist, Forensic	–	–
2080C0008X	Pediatrics, Child Abuse Pediatrics	–	–
2080T0002X	Pediatrics, Medical Toxicology	–	–
2084F0202X	Psychiatry & Neurology, Forensic Psychiatry	–	–
363A00000X	Physician Assistant	–	–
363L00000X	Nurse Practitioner	–	–
363LP0200X	Nurse Practitioner, Pediatrics	–	–

Practice location

11374 Mt View Ave Ste A
Loma Linda, CA 92354-3816

Phone 909-558-6715

Mailing address

File Number 54701
Los Angeles, CA 90074-4701

Phone 909-651-4352 · Fax 909-651-4586

Authorized official

Ricardo Peverini
President
9096515582

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