FACULTY PHYSICIANS AND SURGEONS OF LLUSM (NPI# 1326665415) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326665415 |
| Entity Type | Organization |
| Organization Name | FACULTY PHYSICIANS AND SURGEONS OF LLUSM |
| Practice Address |
4646 Brockton Ave Ste 103 Riverside CA 92506-0103 |
| Mailing Address |
File Number 54701 Los Angeles CA 90074-4701 |
| Practice Telephone | 9095583111 |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2020-07-06 |
| Authorized Official Name | RICARDO PEVERINI (PRESIDENT) |
| Authorized Official Telephone | 9096515582 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207YX0602X |
Otolaryngology Specialization: Otolaryngic Allergy |
Allopathic & Osteopathic Physicians | ||
| N | 207YX0901X |
Otolaryngology Specialization: Otology & Neurotology |
Allopathic & Osteopathic Physicians | ||
| N | 207YX0905X |
Otolaryngology Specialization: Otolaryngology/Facial Plastic Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207YS0012X |
Otolaryngology Specialization: Sleep Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207YS0123X |
Otolaryngology Specialization: Facial Plastic Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207YX0007X |
Otolaryngology Specialization: Plastic Surgery within the Head & Neck |
Allopathic & Osteopathic Physicians | ||
| N | 207YP0228X |
Otolaryngology Specialization: Pediatric Otolaryngology |
Allopathic & Osteopathic Physicians | ||
| N | 231H00000X | Audiologist | Speech, Language and Hearing Service Providers | ||
| N | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Y00000X | Otolaryngology | 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 |
| 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 |
| 1083863914 | Faculty Physicians and Surgeons of Llusm | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 685 N 13th Ave Ste 11, Upland, CA 91786-4963 | 2008-09-16 |
| 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 |
4646 BROCKTON AVE STE 103 |
| City | RIVERSIDE |
| State | CA |
| Zip Code | 92506-0103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902405715 | Riverside Primary Care Clinic, Joanna Ayala Md | Clinic/Center | 3978 Merrill Ave, Riverside, CA 92506 | 2020-10-22 |
| 1336747005 | Beatriz Arredondo | Behavioral Analyst | 6117 Brockton Avenue Ste. 202, Riverside, CA 92506 | 2020-10-14 |
| 1740756782 | Priscilla Marie Rodriguez | Social Worker | 3742 Tibbets St Suite 201, Riverside, CA 92506 | 2018-10-17 |
| 1922593946 | Prevail Health Solutions, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 7450 Chateau Ridge Ln, Riverside, CA 92506 | 2018-06-22 |
| 1831691880 | Mckinley Children's Center | Community/Behavioral Health | 6700 Indiana Avenue, Suite 280, Riverside, CA 92506 | 2018-03-06 |
| 1720590946 | Leticia Dilworth | Behavioral Analyst | 3610 Central Ave Ste 46, Riverside, CA 92506 | 2017-10-27 |
| 1548771736 | Usa Biosciences LLC | Clinical Medical Laboratory | 5750 Division St Ste 109, Riverside, CA 92506 | 2017-10-16 |
| 1922542273 | Yazmar Sevilla-perez | Physical Therapist | 6852 Brockton Ave., Suite 212, Riverside, CA 92506 | 2016-12-06 |
| 1821547605 | Pathway To Healing, Marriage and Family Therapy, Inc. | Marriage & Family Therapist | 5790 Magnolia Ave., Ste 202, Rm F, Riverside, CA 92506 | 2016-09-22 |
| 1952857542 | Kramer and Nguyen Dental Corporation | Dentist | 3602 Riverside Plaza Dr, Ste 101, Riverside, CA 92506 | 2016-09-01 |
| Find all providers in zip 92506 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922613207 | Resurgent Head and Neck Surgeons, Inc. | Otolaryngology | 6848 Magnolia Ave Ste 220, Riverside, CA 92506-2858 | 2020-09-13 |
| 1194086389 | Mary D. Lekas | Otolaryngology | 129 Terrace Ave, Riverside, RI 02915-4726 | 2012-06-04 |
| 1396005740 | David William Hsu | Otolaryngology | 10800 Magnolia Ave, Riverside, CA 92505-3043 | 2012-05-19 |
| 1164757076 | Dae Keun Joo | Otolaryngology | 10800 Magnolia Ave, Riverside, CA 92505-3043 | 2009-10-09 |
| 1558518258 | Jack Liu | Otolaryngology | 10800 Magnolia Ave, Riverside, CA 92505-3043 | 2008-08-25 |
| 1710155452 | Brian Paul Boynton | Otolaryngology | 7117 Brockton Ave, Riverside, CA 92506-2615 | 2008-02-15 |
| 1013198456 | Inland Ear, Head & Neck Clinic | Otolaryngology | 3975 Jackson St, Ste. 202, Riverside, CA 92503-3901 | 2007-11-14 |
| 1649469800 | Piali Policarpio Dattaray | Otolaryngology | 6405 Day St, Riverside, CA 92507-0901 | 2007-10-23 |
| 1558565127 | Murtaza Zakirhusain Kharodawala | Otolaryngology | 10800 Magnolia Ave, Riverside, CA 92505-3043 | 2007-06-14 |
| 1720183403 | Riverside Medical Clinic Inc | Otolaryngology | 7160 Brockton Ave, Riverside, CA 92506 | 2006-09-14 |
| Find all providers in RIVERSIDE | ||||
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| 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.