FACULTY PHYSICIANS AND SURGEONS OF LLUSM (NPI# 1962452714) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962452714 |
| Entity Type | Organization |
| Organization Name | FACULTY PHYSICIANS AND SURGEONS OF LLUSM |
| Practice Address |
2195 Club Center Dr Suite A-l San Bernardino CA 92408-4170 |
| Mailing Address |
File Number 54701 Los Angeles CA 90074-0001 |
| Practice Telephone | 9095582154 |
| Mailing Telephone | 9095583111 |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2009-05-18 |
| Authorized Official Name | RICARDO PEVERINI (PRESIDENT) |
| Authorized Official Telephone | 9095587448 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| Y | 207W00000X | Ophthalmology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0069027 | 05 | |
| CA | GR006902V | 05 |
| 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 |
2195 CLUB CENTER DR SUITE A-L |
| City | SAN BERNARDINO |
| State | CA |
| Zip Code | 92408-4170 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750757217 | Leslie M Dedominic | Speech-Language Pathologist | 2195 Club Center Dr, Suite G, San Bernardino, CA 92408-4170 | 2015-08-18 |
| 1134538564 | Michelle Hong | Psychologist | 2195 Club Center Dr, San Bernardino, CA 92408-4170 | 2014-08-11 |
| 1437570926 | Subhadra Ramanathan | Genetic Counselor, MS | 2195 Club Center Dr, Ste A, San Bernardino, CA 92408-4170 | 2013-12-30 |
| 1376825489 | Danielle Dolores Newton | Speech-Language Pathologist | 2195 Club Center Dr, Suite G, San Bernardino, CA 92408-4170 | 2011-09-14 |
| 1417160847 | Maulin Soneji | Internal Medicine | 2195 Club Center Dr, San Bernardino, CA 92408 | 2007-05-08 |
| 1043233737 | David J Michelson | Pediatrics | 2195 Club Center Dr, Ste A, San Bernardino, CA 92408-4170 | 2006-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073124681 | Valeria Armentilla Cecena | Student in an Organized Health Care Education/Training Program | 1950 Sunwest Ln., San Bernardino, CA 92408 | 2020-08-17 |
| 1588272066 | Horizon Therapy Services | Physical Therapist | 418 East Vanderbilt, San Bernardino, CA 92408 | 2020-07-21 |
| 1821627639 | Bl Anderson Medical Corporation | Emergency Medicine | 473 E Carnegie Dr., Ste 200, San Bernardino, CA 92408 | 2020-04-03 |
| 1922648104 | Infinite Hope Hospice Corp | Hospice Care, Community Based | 225 W Hospitality Ln Suite 305, San Bernardino, CA 92408 | 2020-01-15 |
| 1689210775 | Inland Empire Community Outreach Center | Counselor | 473 East Carnegie Drive, Suite 200, San Bernardino, CA 92408 | 2019-11-23 |
| 1992347801 | Care Marriage and Family Therapists, Inc. | Marriage & Family Therapist | 1881 Commercenter Drive E, Suite 232, San Bernardino, CA 92408 | 2019-10-11 |
| 1366084360 | Theraville Counseling Services, A Licensed Clinical Social Worker Corp | Social Worker | 155 W Hospitality Ln Ste 245, San Bernardino, CA 92408 | 2019-10-10 |
| 1548730419 | Adriana Alcaraz | Behavior Technician | 473 E Carnegie, Ste 200, San Bernardino, CA 92408 | 2018-12-04 |
| 1811467889 | Xavier J Molina-williams | Behavior Technician | 476 E Carnegie Drive, Ste 200, San Bernardino, CA 92408 | 2018-12-03 |
| 1780153148 | Gillian Washington | Behavior Technician | 473 E Carnegie Dr, Ste 200, Riverside, CA 92408 | 2018-11-15 |
| Find all providers in zip 92408 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| 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 Ophthalmology, 2007. http://www.abop.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 Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831490200 | Jonathan David Olenick | Ophthalmology | 2102 Jacaranda Ct., San Bernardino, CA 92404-3300 | 2010-11-16 |
| 1467784389 | Anthony Gregory II | Ophthalmology | 399 E Highland Ave Ste 401, San Bernardino, CA 92404-3862 | 2010-02-02 |
| 1265458293 | Michael Alan Warner | Ophthalmology | 399 E Highland Ave # 150, San Bernardino, CA 92404-3808 | 2006-07-14 |
| 1730104944 | Jennifer A Dunbar | Ophthalmology | 2195 Club Center Dr Ste L, San Bernardino, CA 92408-4162 | 2006-07-12 |
| 1225325129 | Gintien Huang | Ophthalmology | 1909 N Waterman Ave, San Bernardino, CA 92404-4842 | 2011-06-30 |
| 1366652786 | Corinna M Pokorny | Ophthalmology | 1800 Western Ave, Suite 101, San Bernardino, CA 92411-1356 | 2007-05-23 |
| 1336281443 | Edward J Puttre Jr Md Inc | Ophthalmology | 1800 Western Ave, Suite 101, San Bernardino, CA 92411-1356 | 2007-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831790922 | Paul B Kouyoumjian, Md Inc. | Ophthalmology | 18040 Sherman Way Ste 205, Reseda, CA 91335-4631 | 2020-11-04 |
| 1700496320 | William Thomas Parker | Ophthalmology | 5279 Gaylord Pl, San Diego, CA 92117-1034 | 2020-08-07 |
| 1588274724 | Katerina Kurteeva Md Inc | Ophthalmology | 3140 Bear St Ste 100, Costa Mesa, CA 92626-2964 | 2020-08-03 |
| 1285252502 | Eyecare Specialists Medical Group, Inc | Ophthalmology | 58-471 29 Palms Hwy, Yucca Valley, CA 92284-5818 | 2020-07-13 |
| 1407473754 | Janet K. Kim Md, Inc | Ophthalmology | 903 Crenshaw Blvd Ste 105, Los Angeles, CA 90019-1972 | 2020-07-02 |
| 1699392506 | Desert Ophthalmology Medical Corporation | Ophthalmology | 72650 Fred Waring Dr Ste 109, Palm Desert, CA 92260-5008 | 2020-06-26 |
| 1942821566 | Simon Eyes, Inc. | Ophthalmology | 3260 Beard Rd Ste 5, Napa, CA 94558-3466 | 2020-05-05 |
| 1942821905 | Nathan Abraham Md Vision Professionals Inc | Ophthalmology | 24305 Town Center Dr Ste 160, Valencia, CA 91355-1347 | 2020-04-30 |
| 1720609878 | Don Saul Ellis | Ophthalmology | 343 11th St, Del Mar, CA 92014-2607 | 2020-04-29 |
| 1245851534 | Santa Barbara Eyecare Inc., A Professional Medical Corporation | Ophthalmology | 2946 De La Vina St, Santa Barbara, CA 93105-3310 | 2020-04-28 |
| Find all providers with the same taxonomy | ||||
| City | SAN BERNARDINO |
| Zip Code | 92408 |
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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.