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NPI Code Detail

MEDICARE: DR. SAM GINO ADLLIRAD DO

MEDICARE: DR. SAM GINO ADLLIRAD DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207R00000XInternal Medicine Physician1770287583CA

General Provider Information

NPI Number : 1770287583
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SAM GINO ADLLIRAD DO
Provider Business Mailing Address
First Line : 1050 LINDEN AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90813-3321
Country : US
Telephone Number : 562-491-9140
Fax Number : 562-491-9146
Provider Business Practice Location Address
First Line : 1050 LINDEN AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90813-3321
Country : US
Telephone Number : 562-491-9140
Fax Number : 562-491-9146
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2023
Last Update Date : 06/11/2026

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