FACULTY PHYSICIANS AND SURGEONS OF LLUSM - NPI 1124077516

Q: What is the provider's specialty?

The provider's specialty is Pediatrics with taxonomy code 208000000X.

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About Faculty Physicians And Surgeons Of Llusm NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FACULTY PHYSICIANS AND SURGEONS OF LLUSM (NPI 1124077516) is a healthcare organization registered as a pediatrics in San Bernardino, California and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through May 1, 2028 and lists Ricardo Peverini, President, as its authorized official.

NPPES Registry Identity

NPI1124077516

Entity TypeOrganization

Primary Taxonomy208000000X

Legal Business NameFACULTY PHYSICIANS AND SURGEONS OF LLUSM

Location Address250 E CAROLINE ST STE JSan Bernardino, CA 92408-3758

Mailing AddressFile Number 54701Los Angeles, CA 90074-0001 · (909) 558-3111

Phone(909) 651-1900

Organization SubpartNo

Authorized OfficialRicardo PeveriniPresident · (909) 558-7448

Enumeration DateMay 10, 2006

Last NPPES UpdateJuly 19, 2019

✔ NPI 1124077516 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

250 E CAROLINE ST STE J, San Bernardino, CA 92408

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Other Identifiers 1

MedicaidGR006902HCA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0886837

Faculty Physicians And Surgeons Of Llusm · Loma Linda, CA

Active · expires May 1, 2028

CLIA Number05D0886837

Laboratory TypePhysician Office

Certificate Effective DateMay 2, 2026

Certificate Expiration DateMay 1, 2028

Laboratory DirectorChad Vercio

Laboratory Phone(909) 651-1900

Laboratory LocationFaculty Physicians And Surgeons Of Llusm25845 Barton Rd, Bldg F, Ste 101, Loma Linda, CA 92354

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PILAR PICHON M.D.

Psychiatry & Neurology (Neurology with Special Qualifications in Child Neurology)