FACULTY PHYSICIANS AND SURGEONS OF LLUSM (NPI# 1508255175) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508255175 |
| Entity Type | Organization |
| Organization Name | FACULTY PHYSICIANS AND SURGEONS OF LLUSM |
| Practice Address |
1505 Wilson Terrace Suite 155 Glendale CA 91206-4071 |
| Mailing Address |
File # 54701 Los Angeles CA 90074-4701 |
| Practice Telephone | 9095583636 |
| Mailing Telephone | 9095583111 |
| Mailing Fax Number | 9096514586 |
| Enumeration Date | 2015-01-20 |
| 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 | 204F00000X | Transplant Surgery | 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 |
1505 WILSON TERRACE SUITE 155 |
| City | GLENDALE |
| State | CA |
| Zip Code | 91206-4071 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609830348 | Shirley M Chan | Obstetrics & Gynecology | 1505 Wilson Terrace, Suite 350, Glendale, CA 91206-4072 | 2006-04-12 |
| 1427427327 | Honest Cardiology Inc | Internal Medicine | 1505 Wilson Terrace, Suite 320, Glendale, CA 91206-4073 | 2015-09-21 |
| 1093150633 | Carmen Marti | Nurse Practitioner | 1505 Wilson Terrace, Suite #250, Glendale, CA 91206 | 2013-05-09 |
| 1194054015 | Eric J Yavrouian | Otolaryngology | 1505 Wilson Terrace, 270, Glendale, CA 91206-4078 | 2009-12-24 |
| 1467531392 | Clinton Aaron Mitchell | Physician Assistant | 1505 Wilson Terrace, Suite 200, Glendale, CA 91206-4073 | 2006-11-02 |
| 1730262122 | Mihran Shirinian | Internal Medicine | 1505 Wilson Terrace, Suite 340, Glendale, CA 91206 | 2006-10-23 |
| 1104929900 | Michael Frields | Obstetrics & Gynecology | 1505 Wilson Terrace, Suite 130, Glendale, CA 91206 | 2006-09-07 |
| 1871534636 | Gerald M. Pohost | Internal Medicine | 1505 Wilson Terrace, Suite 150, Glendale, CA 61206-4007 | 2006-06-10 |
| 1538125059 | Shirley M Chan M D A Medical Corporation | Obstetrics & Gynecology | 1505 Wilson Terrace, Ste 350, Glendale, CA 91206-4072 | 2006-04-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922611003 | Skyla L Bergin | Behavior Technician | 741 Glenvia St., Suite 200, Glendale, CA 91206 | 2020-08-28 |
| 1861017303 | Scm Nutrition Diet Inc | Dietitian, Registered | 2437 Bywood Drive, Glendale, CA 91206 | 2020-06-10 |
| 1336761295 | Glendale Whole Health | Family Medicine | 230 N Maryland Aave #110, Glendale, CA 91206 | 2020-05-14 |
| 1467010801 | Rebecca Bautista | Counselor | 223 North Jackson Street, Glendale, CA 91206 | 2019-05-31 |
| 1689132920 | M4l Transport Inc | Non-emergency Medical Transport (VAN) | 336 N Louise St #4d, Glendale, CA 91206 | 2019-03-05 |
| 1376042705 | Eileen Wong, Md Inc. | Physical Medicine & Rehabilitation | 2664 E Glenoaks Blvd, Glendale, CA 91206 | 2018-02-12 |
| 1629507900 | Aleksan Chakhoyan | Registered Nurse | 501 N. Glendale Ave., Glendale, CA 91206 | 2017-06-08 |
| 1851793343 | Sevak Olmessekian | Pharmacist | 230 N. Maryland Ave., Suite 307, Glendale, CA 91206 | 2014-09-16 |
| 1558762575 | Zyanya Mendoza | Clinical Neuropsychologist | 1560 E Chevy Chase Dr Ste 140, Glendale, CA 91206 | 2014-09-09 |
| 1629488358 | Nina Behdin | Surgery | 1560 E Chevy Chase Dr Ste 430, Glendale, CA 91206 | 2014-05-02 |
| Find all providers in zip 91206 | ||||
| Taxonomy Code | 204F00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Transplant Surgery |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063829083 | Amit Javed | Transplant Surgery | Ucsf 505 Parnassus Ave M896, Campus Box 0780, San Francisco, CA 94143-0780 | 2014-07-22 |
| 1699039990 | Massimiliano Tuveri | Transplant Surgery | Via Delle Rondini 15, Cagliari, CA 09126 | 2012-07-02 |
| 1457643595 | Neal Martin Mineyev | Transplant Surgery | 2233 Stockton Blvd., Housestaff Building Room 2025, Sacramento, CA 95817 | 2011-05-09 |
| 1790946895 | Ahmad Abou Abbass | Transplant Surgery | 26732 Crown Valley Pkwy Ste 351, Mission Viejo, CA 92691 | 2008-06-20 |
| 1225238538 | Khoa Thomas Anh Pham | Transplant Surgery | 750 Welch Rd Ste 319, Palo Alto, CA 94304-1510 | 2007-07-24 |
| 1356541338 | Raj Mittal | Transplant Surgery | 3400 Lomita Blvd Ste 200, Torrance, CA 90505-4980 | 2007-07-19 |
| 1578760633 | Ayman Al Harakeh | Transplant Surgery | 200 Jose Figueres Ave Ste 225, San Jose, CA 95116 | 2007-06-29 |
| 1063622744 | Ali Cheaito | Transplant Surgery | 11333 N Sepulvelda Blvd, Mission Hills, CA 91345-1116 | 2007-05-23 |
| 1417078882 | Aloke Kumar Mandal | Transplant Surgery | 3110 W Lake Center Dr, Ca152-0243, Santa Ana, CA 92704-6917 | 2007-04-03 |
| 1508909466 | California Pacific Specialty Services | Transplant Surgery | 2302 Fillmore St, Suite A, San Francisco, CA 94115-1813 | 2007-02-14 |
| Find all providers with the same taxonomy | ||||
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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.