FACULTY PHYSICIANS AND SURGEONS OF LLUSM (NPI# 1306372073) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306372073 |
| Entity Type | Organization |
| Organization Name | FACULTY PHYSICIANS AND SURGEONS OF LLUSM |
| Practice Address |
24785 Stewart St Ste 111 Loma Linda CA 92350-1721 |
| Mailing Address |
File # 54701 Los Angeles CA 90074-4701 |
| Practice Telephone | 9095588459 |
| Practice Fax Number | 9096514586 |
| Mailing Telephone | 9095584000 |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2019-07-19 |
| Authorized Official Name | RICARDO PEVERINI (PRESIDENT) |
| Authorized Official Telephone | 9095587448 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2083X0100X |
Preventive Medicine Specialization: Occupational Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2083A0100X |
Preventive Medicine Specialization: Aerospace Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2083B0002X |
Preventive Medicine Specialization: Obesity Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2083C0008X |
Preventive Medicine Specialization: Clinical Informatics |
Allopathic & Osteopathic Physicians | ||
| N | 2083P0011X |
Preventive Medicine Specialization: Undersea and Hyperbaric Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2083P0901X |
Preventive Medicine Specialization: Public Health & General Preventive Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2083S0010X |
Preventive Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2083T0002X |
Preventive Medicine Specialization: Medical Toxicology |
Allopathic & Osteopathic Physicians | ||
| Y | 2083P0500X |
Preventive Medicine Specialization: Preventive Medicine/Occupational Environmental Medicine |
Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144477 | Faculty Physicians and Surgeons of Llusm | Neurological Surgery | 35400 Bob Hope Dr Ste 110, Rancho Mirage, CA 92270-1772 | 2020-11-04 |
| 1700495363 | Faculty Physicians and Surgeons of Llusm | Radiology | 1850 N Riverside Ave Ste 160, Rialto, CA 92376-8056 | 2020-07-29 |
| 1326665415 | Faculty Physicians and Surgeons of Llusm | Otolaryngology | 4646 Brockton Ave Ste 103, Riverside, CA 92506-0103 | 2020-07-06 |
| 1790326825 | Faculty Physicians and Surgeons of Llusm | Urology | 11360 Mt View Ave Ste B, Loma Linda, CA 92354-3834 | 2019-09-30 |
| 1932600335 | Faculty Physicians and Surgeons of Llusm | Internal Medicine | 1200 California St Ste 270, Redlands, CA 92374-2970 | 2018-02-22 |
| 1386162949 | Faculty Physicians and Surgeons of Llusm | Internal Medicine | 197 E Caroline St, San Bernardino, CA 92408 | 2017-09-05 |
| 1588034169 | Faculty Physicians and Surgeons of Llusm | Physician Assistant | 350 S Euclid Ave, Unit C, Upland, CA 91786-6665 | 2015-09-25 |
| 1912343104 | Faculty Physicians and Surgeons of Llusm | Pediatrics | 1101 N Euclid Ave, Upland, CA 91786-3233 | 2013-05-15 |
| 1457680530 | Faculty Physicians and Surgeons of Llusm | Pediatrics | 12021 Jacaranda Ave., Hesperia, CA 92345-4956 | 2009-12-18 |
| 1265686109 | Faculty Physicians and Surgeons of Llusm | Pathology | 11234 Anderson St Ste 1617, Loma Linda, CA 92354-2804 | 2008-11-05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | FACULTY PHYSICIANS AND SURGEONS OF LLUSM | 11370 Anderson St, Loma Linda, CA 92354-3450 |
| Street Address |
24785 STEWART ST STE 111 |
| City | LOMA LINDA |
| State | CA |
| Zip Code | 92350-1721 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164637872 | April Engle Wilson | Preventive Medicine | 24785 Stewart St, Evans Hall Suite 111, Loma Linda, CA 92350-1721 | 2007-05-14 |
| 1588128177 | Ashley Erazo | Physician Assistant | 24785 Stewart St, Loma Linda, CA 92350-1721 | 2019-01-28 |
| 1144725854 | Rafik Saleh | Student in an Organized Health Care Education/Training Program | 24785 Stewart St, Loma Linda, CA 92350 | 2018-03-26 |
| 1891181269 | Courtney Marquez | Physician Assistant | 24785 Stewart St, Evans Hall Room 201, Loma Linda, CA 92350-1721 | 2015-04-12 |
| 1316369051 | Avery Karyn Erickson Anderson | Registered Nurse | 24785 Stewart St, Loma Linda, CA 92350-1721 | 2014-01-15 |
| 1487972261 | Aileen Kit Ying Lo | Preventive Medicine | 24785 Stewart St, Suite 204, Loma Linda, CA 92350-1721 | 2010-05-04 |
| 1528383528 | Megan Jonee Volkov | Nurse Practitioner | 24785 Stewart St, Loma Linda, CA 92354-2751 | 2010-04-01 |
| 1356670392 | Janet E Hackleman | Marriage & Family Therapist | 24785 Stewart St, Loma Linda, CA 92354-2751 | 2009-12-22 |
| 1023258290 | Serena Tonstad | Preventive Medicine | 24785 Stewart St, Evans Hall, Room 111, Loma Linda, CA 92350-0001 | 2009-03-02 |
| 1356550909 | Stephen Kiran Kumar | Preventive Medicine | 24785 Stewart St, Evans Hall, Room 101, Loma Linda, CA 92350-0001 | 2007-05-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164059010 | Stephanie Abandy | Student in an Organized Health Care Education/Training Program | 11262 Campus Street - West Hall, West Hall, Loma Linda, CA 92350 | 2020-03-23 |
| 1275911844 | Rosemarie Florian | Internal Medicine | 11234 Anderson St Rm 1503, Loma Linda, CA 92350 | 2015-05-14 |
| 1235525403 | Diana Derosa Villarreal | Pediatrics | 11175 Campus St. Cp-a1111, Department of Pediatrics, Loma Linda, CA 92350 | 2015-04-14 |
| 1609212919 | Daniel Eldridge Smith | Surgery | 11175 Campus St # 21111, Loma Linda, CA 92350 | 2013-05-14 |
| 1992057269 | Hildemar Feliciano Dos Santos | Nutritionist | 25040 Stewart Street, Loma Linda, CA 92350 | 2012-10-10 |
| 1184910762 | Kristyn Anne Mannoia | Surgery | 11234 Anderson Ave Ste 2100, Loma Linda, CA 92350 | 2011-06-22 |
| 1760774947 | Loma Linda University | Special Hospital | 1234 Anderson Street, Gme Office Csp 21005, Loma Linda, CA 92350 | 2011-05-06 |
| 1144547977 | Andrei Radulescu | Surgery | 11175 Campus St Ste 21111, Loma Linda, CA 92350 | 2010-05-04 |
| 1619102845 | Wing Sze Esther Yung | Surgery | 11175 Campus Street #21111, Loma Linda Universiy Healthcare System, Loma Linda, CA 92350 | 2009-05-18 |
| 1679720734 | Ronald Lee Young | Dentist | 11092 Anderson Streeet, Llu School of Dentistry, Loma Linda, CA 92350 | 2008-08-20 |
| Find all providers in zip 92350 | ||||
| Taxonomy Code | 2083P0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Preventive Medicine/Occupational Environmental Medicine |
| A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578700332 | Haitham Jamil Juma | Preventive Medicine | 11234 Anderson St, House of Staffing, Loma Linda, CA 92354-2804 | 2009-01-15 |
| 1699927178 | Matthew Chan | Preventive Medicine | 25455 Barton Road, Suite 106b, Loma Linda, CA 92354-2804 | 2008-10-16 |
| 1790892669 | Ann Linda Dew | Preventive Medicine | 11201 Benton St, Loma Linda, CA 92357-1000 | 2006-08-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750911665 | Healthstat Wellness Sutter County | Preventive Medicine | 1215 Plumas St Ste 1300a, Yuba City, CA 95991-3400 | 2020-01-20 |
| 1194373530 | Healthstat Wellness County of Santa Barbara Headquarters | Preventive Medicine | 427 Camino Del Remedio Bldg G, Santa Barbara, CA 93110-1310 | 2019-08-29 |
| 1023678661 | Linda K Watanabe | Preventive Medicine | 700 Bay Rd. #2803, Redwood City, CA 94063 | 2019-06-17 |
| 1750872255 | Universal Occupational Medicine PC | Preventive Medicine | 8303 Brimhall Rd Bldg 1500, Bakersfield, CA 93312-2243 | 2018-05-21 |
| 1831694272 | Healthstat Wellness County Sb Headquarters | Preventive Medicine | 2500 Broadway Ste 400, Santa Monica, CA 90404-3176 | 2018-03-28 |
| 1326548363 | Paul Manchester | Preventive Medicine | 11159 Corte Pleno Verano, San Diego, CA 92130-2688 | 2018-02-16 |
| 1295240679 | Robert A Brooks | Preventive Medicine | 149 South Barrington Ave, #346, Los Angeles, CA 90049 | 2017-12-07 |
| 1285145383 | Brett V. Curtis M.d. & Associates, A Professional Corporation | Preventive Medicine | 7428 Redwood Blvd Ste 100, Novato, CA 94945-2418 | 2017-10-16 |
| 1104355783 | Susan Bradshaw | Preventive Medicine | 6320 W Howard Drollinger Way Ste 203, Los Angeles, CA 90045-3627 | 2017-06-07 |
| 1386097806 | Healthstat Wellness Bac Madera | Preventive Medicine | 15341 Road 28 1/2, Madera, CA 93638-2325 | 2016-07-20 |
| Find all providers with the same taxonomy | ||||
| City | LOMA LINDA |
| Zip Code | 92350 |
Please comment or provide details below to improve the information on FACULTY PHYSICIANS AND SURGEONS OF LLUSM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.