FACULTY PHYSICIANS AND SURGEONS OF LLUSM (NPI# 1275191926) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275191926 |
| Entity Type | Organization |
| Organization Name | FACULTY PHYSICIANS AND SURGEONS OF LLUSM |
| Practice Address |
26520 Cactus Ave Moreno Valley CA 92555-3927 |
| Mailing Address |
File Number 54701 Los Angeles CA 90074-4701 |
| Practice Telephone | 9095584000 |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2019-07-22 |
| 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 | 207ZP0213X |
Pathology Specialization: Pediatric 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 | ||
| N | 207ZI0100X |
Pathology Specialization: Immunopathology |
Allopathic & Osteopathic Physicians | ||
| N | 207ZM0300X |
Pathology Specialization: Medical Microbiology |
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 | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
Allopathic & Osteopathic Physicians | ||
| N | 207ZP0104X |
Pathology Specialization: Chemical Pathology |
Allopathic & Osteopathic Physicians | ||
| N | 207ZP0105X |
Pathology Specialization: Clinical Pathology/Laboratory Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 207ZC0006X |
Pathology Specialization: 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 |
26520 CACTUS AVE |
| City | MORENO VALLEY |
| State | CA |
| Zip Code | 92555-3927 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477546414 | Menard Barruga | Pediatrics | 26520 Cactus Ave, Moreno Valley, CA 92555-3927 | 2005-08-24 |
| 1942816392 | Sheron Mathew | Physician Assistant | 26520 Cactus Ave, Moreno Valley, CA 92555-3927 | 2020-09-21 |
| 1669086237 | Brittany Noel Speer | Physician Assistant | 26520 Cactus Ave, Moreno Valley, CA 92555-3927 | 2020-09-01 |
| 1548873110 | Garrett Bao Kha Tran Long | Student in an Organized Health Care Education/Training Program | 26520 Cactus Ave, Moreno Valley, CA 92555-3927 | 2020-08-25 |
| 1639782063 | Yinxi Wu | Social Worker | 26520 Cactus Ave, Moreno Valley, CA 92555-3927 | 2020-08-25 |
| 1124636246 | Marie Therese Fonseca | Counselor | 26520 Cactus Ave, Moreno Valley, CA 92555-3927 | 2020-07-15 |
| 1396363545 | Jackson Helms | Student in an Organized Health Care Education/Training Program | 26520 Cactus Ave, Moreno Valley, CA 92555-3927 | 2020-07-13 |
| 1588282024 | Adam Kreutzer | Orthopaedic Surgery | 26520 Cactus Ave, Moreno Valley, CA 92555-3927 | 2020-07-10 |
| 1861010316 | Nicholas Bast | Student in an Organized Health Care Education/Training Program | 26520 Cactus Ave, Moreno Valley, CA 92555-3927 | 2020-07-10 |
| 1699392449 | Xiao Song | Student in an Organized Health Care Education/Training Program | 26520 Cactus Ave, Moreno Valley, CA 92555-3927 | 2020-06-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043817935 | Jillian Mika Ogata | Social Worker | Riverside University Health System, 26520 Cactus Ave., Moreno Valley, CA 92555 | 2020-10-05 |
| 1114549144 | Providence Recovery Centers, Inc. | Substance Abuse Rehabilitation Facility | 11165 Bonnie View Ave, Moreno Valley, CA 92555 | 2020-05-13 |
| 1720645096 | Shahida Nawaz | Non-emergency Medical Transport (VAN) | 26528 Primrose Way, Moreno Valley, CA 92555 | 2019-05-22 |
| 1679139828 | Moses Lee | Student in an Organized Health Care Education/Training Program | Department of Orthopaedic Surgery Rm. B2042 Ruhs-mc, 26520 Cactus Ave., Moreno Valley, CA 92555 | 2019-05-14 |
| 1215419668 | Johannes Wattimena | Counselor | 26624 Saffron Circle, Moreno Valley, CA 92555 | 2018-09-02 |
| 1437676939 | Aleksandra Vargas | Behavioral Analyst | 12549 Atherton Dr, Moreno Valley, CA 92555 | 2017-08-25 |
| 1063938603 | Anthony I Odimegwu | Nurse Practitioner | 26062 Bercaw Ct, Moreno Valley, CA 92555 | 2017-08-16 |
| 1073036703 | Karen Parker | Licensed Psychiatric Technician | 12944 Dolomite Lane, Moreno Valley, CA 92555 | 2017-07-25 |
| 1861923674 | Elena Vizcaino | Behavior Technician | 15670 Turnberry St, Moreno Valley, CA 92555 | 2017-03-23 |
| 1154744522 | Nancy Chivichon | Dietitian, Registered | 28648 Avenue Ave., Moreno Valley, CA 92555 | 2014-01-21 |
| Find all providers in zip 92555 | ||||
| Taxonomy Code | 207ZC0006X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | 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: new, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic "clinical pathology only" 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 |
|---|---|---|---|---|
| 1568073351 | Frank Connors | Pathology | 555 S Los Robles Ave Apt 1, Pasadena, CA 91101-3241 | 2020-08-14 |
| 1083233407 | Super Lab Diagnostics Inc | Pathology | 11755 Victory Blvd Ste 250, North Hollywood, CA 91606-3481 | 2020-04-15 |
| 1548896491 | Jacob William Jorgensen | Pathology | 154 Black Powder Cir, Folsom, CA 95630-3415 | 2020-03-22 |
| 1457773608 | Ian Finn | Pathology | 12786 Salmon River Rd, San Diego, CA 92129-3553 | 2014-01-07 |
| 1760820518 | William Joseph Keenan | Pathology | 408 Sunrise Ave, Suite 1, Roseville, CA 95661 | 2013-06-13 |
| 1972801926 | Richard Deane Hockett Jr. | Pathology | 10520 Wateridge Cir, San Diego, CA 92121-5782 | 2011-02-28 |
| 1043531056 | Edward Taylor Sittler | Pathology | 680 2nd St, San Francisco, CA 94107 | 2010-06-14 |
| 1942536123 | Tara Ann Saunders | Pathology | 505 Parnassus Ave M580, San Francisco, CA 94143 | 2009-10-23 |
| 1992031132 | Victory Care Inc | Pathology | 2131 Elks Dr Ste 103, San Bernardino, CA 92404-5571 | 2009-10-22 |
| 1215174503 | Alan L.ee Epstein | Pathology | Usc Keck School of Medicine, 2011 Zonal Avenue, Hmr 205, Los Angeles, CA 90089-0001 | 2009-01-08 |
| Find all providers with the same taxonomy | ||||
| City | MORENO VALLEY |
| Zip Code | 92555 |
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.