Faculty Physicians and Surgeons of Llusm

Organization Active NPI Pediatrics Physician · Moreno Valley, CA

NPI 1073563748 · NPPES record last updated Sep 22, 2025

Key facts

NPI
1073563748
Entity type
Organization (NPI type 2)
Primary specialty
Pediatrics Physician 208000000X
Legal business name
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Practice address
11441 Heacock St
Suite C
Moreno Valley, CA 92557-7907
Phone
(951) 247-5809
Fax
(909) 558-3905
NPI assigned
May 11, 2006
Organization subpart
No

Authorized official

Name
Ricardo Peverini, M.D.
Title
President
Phone
(909) 558-7448

Practitioners 352

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 352

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031211000981 CA Part B Supplier - Clinic/Group Practice 1153227814 Receives reassigned benefits from 2,632 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician
Group: 193200000X MULTI-SPECIALTY GROUP
208000000X Yes

Addresses

Primary practice location

11441 Heacock St
Suite C
Moreno Valley, CA 92557-7907

Mailing address

File Number 54701
Los Angeles, CA 90074-0001
Phone (909) 558-3111

Other identifiers

IdentifierTypeStateIssuer
GR006902LMedicaidCA

Other providers in Moreno Valley, CA

All providers in Moreno Valley, CA · Pediatrics Physician in California

Sources for this page

Verify at the official NPI Registry.