Provider Demographics
NPI:1891351565
Name:JOSEPH, AVERY (DO)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:
Credentials:DO
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Mailing Address - Street 1:15965 LOS GATOS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3415
Mailing Address - Country:US
Mailing Address - Phone:408-358-1855
Mailing Address - Fax:
Practice Address - Street 1:15965 LOS GATOS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3415
Practice Address - Country:US
Practice Address - Phone:408-358-1855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A23247208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery