Healthcare Provider Details

I. General information

NPI: 1558295881
Provider Name (Legal Business Name): STEPHEN J. GEORGIOU MD, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 I ST
LOS BANOS CA
93635-4313
US

IV. Provider business mailing address

PO BOX 92
LOS BANOS CA
93635-0092
US

V. Phone/Fax

Practice location:
  • Phone: 209-828-5580
  • Fax: 209-828-5599
Mailing address:
  • Phone: 209-828-5580
  • Fax: 209-828-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN JOHN GEORGIOU
Title or Position: MD/ PRESIDENT
Credential: MD
Phone: 209-617-0796