Provider Demographics
NPI:1669686796
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:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGLIANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-491-9281
Mailing Address - Street 1:1045 ATLANTIC AVENUE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1045 ATLANTIC AVENUE
Practice Address - Street 2:SUITE 611
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813
Practice Address - Country:US
Practice Address - Phone:562-437-2801
Practice Address - Fax:562-432-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0015761Medicaid
CAZZZ69885ZOtherBLUE SHIELD OF CALIFORNIA
CAW13421PPMedicare PIN