FACULTY PHYSICIANS AND SURGEONS OF LLUSM (NPI# 1093117962) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093117962 |
| Entity Type | Organization |
| Organization Name | FACULTY PHYSICIANS AND SURGEONS OF LLUSM |
| Practice Address |
359 San Miguel Dr Ste 105 Newport Beach CA 92660-7812 |
| Mailing Address |
File # 54701 Los Angeles CA 90074-4701 |
| Practice Telephone | 9095582880 |
| Mailing Telephone | 9095583111 |
| Mailing Fax Number | 9096514586 |
| Enumeration Date | 2014-09-22 |
| 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 | 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 | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
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 |
359 SAN MIGUEL DR STE 105 |
| City | NEWPORT BEACH |
| State | CA |
| Zip Code | 92660-7812 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619993698 | Luz Elena Cano | Internal Medicine | 359 San Miguel Dr, Suite 105, Newport Beach, CA 92660-7812 | 2006-07-14 |
| 1750817219 | Karen K. Leong Medical Corporation | Plastic Surgery | 359 San Miguel Dr, #300, Newport Beach, CA 92660-7812 | 2017-05-03 |
| 1780030205 | Victoria Valeri Dolidze | Massage Therapist | 359 San Miguel Dr, Suite 303, Newport Beach, CA 92660 | 2016-05-13 |
| 1255735593 | Zenovia H Gabriel, A Medical Corporation | Dermatology | 359 San Miguel Dr, Suite 300, Newport Beach, CA 92660-7812 | 2014-10-15 |
| 1316340268 | Leur Medicine Inc | Dermatology | 359 San Miguel Dr, Suite 300, Newport Beach, CA 92660-7812 | 2014-10-07 |
| 1063720217 | David J. Lang,md | Specialist | 359 San Miguel Dr, Suite 206, Newport Beach, CA 92660-7812 | 2010-09-22 |
| 1174798912 | Luz Elena Cano Md Inc | Internal Medicine | 359 San Miguel Dr, Suite 105, Newport Beach, CA 92660-7812 | 2008-04-23 |
| 1003018474 | David J. Lang, Md, Inc | Pediatrics | 359 San Miguel Dr, 206, Newport Beach, CA 92660-7812 | 2007-06-05 |
| 1033246228 | Walton James Montegut | Specialist | 359 San Miguel Dr, Suite 206, Newport Beach, CA 92660-7812 | 2007-02-27 |
| 1144387952 | Jonathan David Shifren | Surgery | 359 San Miguel Dr, Suite 206, Newport Beach, CA 92660-7812 | 2007-01-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275144024 | Lumins Aesthetic and Wellness, Inc | Dermatology | 20281 Sw Birch St, Suite 201, Newport Beach, CA 92660 | 2020-08-14 |
| 1205445798 | Felecia A Pedrogo | Marriage & Family Therapist | 5020 Campus Street, Newport Beach, CA 92660 | 2020-07-30 |
| 1649898388 | Polyviou Dental Corportation, Inc. | Clinic/Center | 120 Newport Beach Drive, Suite 27, Newport Beach, CA 92660 | 2020-07-09 |
| 1154974525 | Jan M. Eckermann, Md Inc. | Neurological Surgery | 1617 W Cliff Dr, Ste 203, Newport Beach, CA 92660 | 2019-07-24 |
| 1235792219 | Horizon Dermatology and Laser Institute | Dermatology | 369 San Miguel Dr. Suite 200, Newport Beach, CA 92660 | 2019-04-16 |
| 1902366925 | Yasmine Central Gohar | Marriage & Family Therapist | 20271 Sw Birch St Ste 200, Newport Beach, CA 92660 | 2019-03-25 |
| 1245703255 | Charison Counseling | Counselor | 4000 Macarthur Bvd Suite 600 East Tower, Newport Beach, CA 92660 | 2019-01-03 |
| 1134698996 | Amber Werner | Chiropractor | 4029 Westerly Place, Suite #115, Newport Beach, CA 92660 | 2018-11-21 |
| 1861969008 | Healthy Me Oc | Dietitian, Registered | 4569 Macarthur Court, Suite 1100, Newport Beach, CA 92660 | 2018-10-25 |
| 1174015192 | Edwin Enwia | Clinic/Center | 1000 Bristol St N Ste 1b, Newport Beach, CA 92660 | 2018-06-05 |
| Find all providers in zip 92660 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538504733 | Shawn Zardouz | Psychiatry & Neurology | 3900 W Coast Hwy Ste 390, Newport Beach, CA 92663 | 2013-05-02 |
| 1518053289 | Janet Mary Chance | Psychiatry & Neurology | 510 Superior Ave Ste 200a, Newport Beach, CA 92663-3663 | 2006-10-04 |
| 1467482216 | Daniel S. Bandari | Psychiatry & Neurology | 3900 W Coast Hwy, Suite 330, Newport Beach, CA 92663-4091 | 2006-07-04 |
| 1043258502 | Valerie Valentine Acevedo | Psychiatry & Neurology | 20072 Sw Birch St, Suite 170, Newport Beach, CA 92660-0794 | 2006-06-04 |
| 1265078786 | Shankle Clinic | Psychiatry & Neurology | 3900 W Coast Hwy Ste 310, Newport Beach, CA 92663-4093 | 2019-11-19 |
| 1972072999 | Saulena Shafer D.o., Inc. | Psychiatry & Neurology | 510 Superior Ave Ste 200a, Newport Beach, CA 92663-3664 | 2018-11-20 |
| 1669790309 | Newport Neurohospitalist Medical Group, Inc | Psychiatry & Neurology | 500 Superior Ave, Suite 305, Newport Beach, CA 92663-3657 | 2010-05-05 |
| 1972743821 | Daniel S. Bandari, M.d. Inc | Psychiatry & Neurology | 3900 W Coast Hwy, Suite 330, Newport Beach, CA 92663-4091 | 2009-03-04 |
| 1740454586 | Sandeep K Thakkar | Psychiatry & Neurology | 510 Superior Ave, Suite 200-a, Newport Beach, CA 92663-3663 | 2008-04-14 |
| 1376742700 | Jose Puangco | Psychiatry & Neurology | 510 Superior Ave, Suite 200-a, Newport Beach, CA 92663-3663 | 2007-07-16 |
| Find all providers in NEWPORT BEACH | ||||
| City | NEWPORT BEACH |
| Zip Code | 92660 |
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.