Provider Demographics
NPI:1073010799
Name:STATHOS, JOSEPH GREGORY (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GREGORY
Last Name:STATHOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2246
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-1246
Mailing Address - Country:US
Mailing Address - Phone:562-490-9900
Mailing Address - Fax:
Practice Address - Street 1:701 E 28TH ST STE 419
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2775
Practice Address - Country:US
Practice Address - Phone:562-490-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA19098207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology