Provider Demographics
NPI:1972236610
Name:STATHIS, BARBARA (NP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:STATHIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 E 3RD ST APT 6
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3612
Mailing Address - Country:US
Mailing Address - Phone:310-429-5872
Mailing Address - Fax:
Practice Address - Street 1:801 E KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6614
Practice Address - Country:US
Practice Address - Phone:714-633-6373
Practice Address - Fax:714-633-1443
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021468363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health