Provider Demographics
NPI:1437281409
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:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-299-5200
Mailing Address - Street 1:3661 TORRANCE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4887
Mailing Address - Country:US
Mailing Address - Phone:310-540-7240
Mailing Address - Fax:
Practice Address - Street 1:3661 TORRANCE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4887
Practice Address - Country:US
Practice Address - Phone:310-540-7240
Practice Address - Fax:310-540-7280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR006415KMedicaid
CAZZZ53300ZOtherBLUE SHIELD GROUP NUMBER
CAGR006415KMedicaid