Healthcare Provider Details

I. General information

NPI: 1770287583
Provider Name (Legal Business Name): SAM GINO ADLLIRAD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 CITRACADO PKWY
ESCONDIDO CA
92029-4159
US

IV. Provider business mailing address

2185 CITRACADO PKWY
ESCONDIDO CA
92029-4159
US

V. Phone/Fax

Practice location:
  • Phone: 442-281-5000
  • Fax:
Mailing address:
  • Phone: 442-281-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1770287583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: