Healthcare Provider Details

I. General information

NPI: 1073010799
Provider Name (Legal Business Name): JOSEPH GREGORY STATHOS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST STE 418
LONG BEACH CA
90806-2794
US

IV. Provider business mailing address

PO BOX 2246
SEAL BEACH CA
90740-1246
US

V. Phone/Fax

Practice location:
  • Phone: 562-490-9900
  • Fax:
Mailing address:
  • Phone: 562-490-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19098
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number19098
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number19098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: