Provider Demographics
NPI:1558413765
Name:ARVANITIDIS, DEMETRA STATHOPOULOS (MD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRA
Middle Name:STATHOPOULOS
Last Name:ARVANITIDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 N LIMA ST
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-1048
Mailing Address - Country:US
Mailing Address - Phone:626-355-2013
Mailing Address - Fax:
Practice Address - Street 1:377 N LIMA ST
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-1048
Practice Address - Country:US
Practice Address - Phone:626-355-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77808208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics