Provider Demographics
NPI:1902407711
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:COO
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:562-299-5239
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:
Mailing Address - Fax:
Practice Address - Street 1:3700 KATELLA AVE STE D
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6410
Practice Address - Country:US
Practice Address - Phone:562-855-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty