Provider Demographics
NPI:1356474852
Name:PROHEALTH PARTNERS, A MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:PROHEALTH PARTNERS, A MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ALLSWANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-299-5200
Mailing Address - Street 1:5150 E PACIFIC COAST HWY STE 500
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3328
Mailing Address - Country:US
Mailing Address - Phone:562-299-5200
Mailing Address - Fax:
Practice Address - Street 1:1045 ATLANTIC AVE STE 812
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3424
Practice Address - Country:US
Practice Address - Phone:562-435-5353
Practice Address - Fax:562-491-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ47089ZOtherBLUE SHIELD GROUP NUMBER
CAGR0064159Medicaid
CAW13421DMedicare PIN