Provider Demographics
NPI:1093300741
Name:PROHEALTH PARTNERS A MEDICAL GROUP
Entity Type:Organization
Organization Name:PROHEALTH PARTNERS A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-299-5239
Mailing Address - Street 1:1771 W ROMNEYA DR STE H
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1817
Mailing Address - Country:US
Mailing Address - Phone:562-583-2250
Mailing Address - Fax:
Practice Address - Street 1:1771 W ROMNEYA DR STE H
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1817
Practice Address - Country:US
Practice Address - Phone:562-583-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty