Healthcare Provider Details

I. General information

NPI: 1093300741
Provider Name (Legal Business Name): PROHEALTH PARTNERS A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 W ROMNEYA DR STE I
ANAHEIM CA
92801-1807
US

IV. Provider business mailing address

1761 W ROMNEYA DR STE I
ANAHEIM CA
92801-1807
US

V. Phone/Fax

Practice location:
  • Phone: 562-583-2250
  • Fax: 562-583-2254
Mailing address:
  • Phone: 562-583-2250
  • Fax: 562-853-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER FERRERA
Title or Position: PRESIDENT
Credential:
Phone: 562-299-5200