Provider Demographics
NPI:1528191483
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:MD
Authorized Official - Phone:562-299-5200
Mailing Address - Street 1:1045 ATLANTIC AVE STE 1019
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3413
Mailing Address - Country:US
Mailing Address - Phone:562-901-9228
Mailing Address - Fax:562-437-5103
Practice Address - Street 1:1045 ATLANTIC AVE STE 1019
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813
Practice Address - Country:US
Practice Address - Phone:562-901-9228
Practice Address - Fax:562-437-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ51209ZOtherBLUE SHIELD GROUP NUMBER
CAGR0064154Medicaid
CAW13421PMedicare PIN