Healthcare Provider Details

I. General information

NPI: 1467451880
Provider Name (Legal Business Name): LUCA VASSALLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E 2ND AVE
ESCONDIDO CA
92025-4212
US

IV. Provider business mailing address

225 E 2ND AVE
ESCONDIDO CA
92025-4212
US

V. Phone/Fax

Practice location:
  • Phone: 760-291-6700
  • Fax:
Mailing address:
  • Phone: 760-291-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD-6087
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG71049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: