FACULTY PHYSICIANS AND SURGEONS OF LLUSM (NPI# 1245605781) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245605781 |
| Entity Type | Organization |
| Organization Name | FACULTY PHYSICIANS AND SURGEONS OF LLUSM |
| Practice Address |
11234 Anderson St Loma Linda CA 92354-2804 |
| Mailing Address |
File # 54701 Los Angeles CA 90074-4701 |
| Practice Telephone | 9095586122 |
| Practice Fax Number | 9096514586 |
| Mailing Telephone | 9096514000 |
| Mailing Fax Number | 9096514586 |
| Enumeration Date | 2015-12-09 |
| 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 | 207ZP0104X |
Pathology Specialization: Chemical Pathology |
Allopathic & Osteopathic Physicians | ||
| N | 207ZP0105X |
Pathology Specialization: Clinical Pathology/Laboratory Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207ZP0213X |
Pathology Specialization: Pediatric Pathology |
Allopathic & Osteopathic Physicians | ||
| N | 207ZM0300X |
Pathology Specialization: Medical Microbiology |
Allopathic & Osteopathic Physicians | ||
| N | 207ZI0100X |
Pathology Specialization: Immunopathology |
Allopathic & Osteopathic Physicians | ||
| N | 207ZN0500X |
Pathology Specialization: Neuropathology |
Allopathic & Osteopathic Physicians | ||
| N | 207ZP0007X |
Pathology Specialization: Molecular Genetic Pathology |
Allopathic & Osteopathic Physicians | ||
| N | 207ZP0101X |
Pathology Specialization: Anatomic Pathology |
Allopathic & Osteopathic Physicians | ||
| N | 207ZC0006X |
Pathology Specialization: Clinical Pathology |
Allopathic & Osteopathic Physicians | ||
| N | 207ZB0001X |
Pathology Specialization: Blood Banking & Transfusion Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207ZC0500X |
Pathology Specialization: Cytopathology |
Allopathic & Osteopathic Physicians | ||
| N | 207ZD0900X |
Pathology Specialization: Dermatopathology |
Allopathic & Osteopathic Physicians | ||
| N | 207ZF0201X |
Pathology Specialization: Forensic Pathology |
Allopathic & Osteopathic Physicians | ||
| N | 207ZH0000X |
Pathology Specialization: Hematology |
Allopathic & Osteopathic Physicians | ||
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
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 |
11234 ANDERSON ST |
| City | LOMA LINDA |
| State | CA |
| Zip Code | 92354-2804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891794657 | Leigh Ann Ballou | Physician Assistant | 11234 Anderson St, Rm 2562b, Loma Linda, CA 92354-2804 | 2005-07-14 |
| 1285233759 | Daemian Alexander Martin Sr. | Registered Nurse | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-10-25 |
| 1922610450 | Samantha Zepeda Merchant | Registered Nurse | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-08-17 |
| 1609493451 | Romina Mcgalliard | Registered Nurse | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-06-27 |
| 1811514854 | Christopher Jihoon Kim | Student in an Organized Health Care Education/Training Program | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-06-25 |
| 1912523135 | Shelly Marie Bogue | Student in an Organized Health Care Education/Training Program | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-06-23 |
| 1962028613 | Sikai Song | Student in an Organized Health Care Education/Training Program | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-06-18 |
| 1720604515 | Nelson Horsley | Student in an Organized Health Care Education/Training Program | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-06-17 |
| 1134744055 | Teddy Matthew Mumu | Student in an Organized Health Care Education/Training Program | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-06-16 |
| 1124643135 | Kristofer John Vance | Student in an Organized Health Care Education/Training Program | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-06-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588264337 | Apple Red Nutrition Services | Dietitian, Registered | 357 W. 2nd St, Suite #2, Loma Linda, CA 92354 | 2020-10-30 |
| 1013517960 | Kristina Pulliam Markey | Nurse Practitioner | 11234 Anderson Strreet, Loma Linda, CA 92354 | 2020-10-29 |
| 1932725645 | Dev Priya Singhvi | Student in an Organized Health Care Education/Training Program | 11332 Mountain View Avenue, Westerly Building, Suite C, Gme Office, Loma Linda, CA 92354 | 2020-06-18 |
| 1750901278 | Angela N Torres | Student in an Organized Health Care Education/Training Program | Loma Linda University Health Emergency Medicine, 11234 Anderson Street, Loma Linda, CA 92354 | 2020-04-24 |
| 1548899230 | Holistic Physical Therapy Inc. | Physical Therapist | 25003 Starr Str, Loma Linda, CA 92354 | 2020-04-03 |
| 1508494071 | Eric Allen | Student in an Organized Health Care Education/Training Program | Loma Linda University Health Pediatrics, General, 11234 Anderson Street, Loma Linda, CA 92354 | 2020-03-31 |
| 1730640244 | Rose Valley Rcfe | Assisted Living Facility | 11574 Poplar St, Loma Linda, CA 92354 | 2019-03-27 |
| 1336633676 | David A Lawrence | Student in an Organized Health Care Education/Training Program | Loma Linda University Hospital, 11234 Anderson St., Loma Linda, CA 92354 | 2018-06-20 |
| 1205329547 | Rachael Nicole Spady | Student in an Organized Health Care Education/Training Program | Loma Linda University Health - Obstetrics & Gynecology, 11234 Anderson St, Loma Linda, CA 92354 | 2018-06-12 |
| 1447756069 | Anthony Ernest Sanchez | Otolaryngology | 11332 Mountain View, Westerly Building Suite C, Loma Linda, CA 92354 | 2018-04-03 |
| Find all providers in zip 92354 | ||||
| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871771238 | Yvonne Saldanha Noronha | Pathology | 26266 Cresthaven Ct, Loma Linda, CA 92354-4138 | 2008-02-07 |
| 1881715456 | Heather Lynn Rojas | Pathology | 11863 Columbia Ct, Loma Linda, CA 92354-6755 | 2007-04-02 |
| 1023545605 | Yahya Daneshbod | Pathology | 11234 Anderson Street, Gme Office Westerly Suite C, Loma Linda, CA 92354-2804 | 2017-05-15 |
| 1063877959 | Irene Thung | Pathology | 11201 Benton Street, Dept. of Pathology (113), Loma Linda, CA 92357 | 2015-12-21 |
| 1306256292 | Robin Lloyd Dietz Jr. | Pathology | 11234 Anderson St, Loma Linda University Medical Center - Pathology, Loma Linda, CA 92354-2804 | 2014-05-01 |
| 1952561110 | Amita T. Mistry | Pathology | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2008-06-11 |
| 1730399932 | Yamil Lopez | Pathology | 11234 Anderson St, Suite 2151, Loma Linda, CA 92354-2804 | 2007-05-23 |
| 1265640023 | Shobha L. Castelino - Prabhu | Pathology | 11370 Anderson St, Suite 2950, Loma Linda, CA 92354-3450 | 2007-05-17 |
| 1538375217 | Jin Guo | Pathology | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2007-05-16 |
| 1316957418 | Resa Louise Chase | Pathology | 11201 Benton Street, Loma Linda Va Med Center, Lab Med (113), Loma Linda, CA 92357 | 2006-08-09 |
| Find all providers in LOMA LINDA | ||||
| City | LOMA LINDA |
| Zip Code | 92354 |
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.