Healthcare Provider Details

I. General information

NPI: 1326700626
Provider Name (Legal Business Name): PROHEALTH PARTNERS A MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 JEFFERSON AVE STE 2
CHINO CA
91710-3522
US

IV. Provider business mailing address

5150 E PACIFIC COAST HWY STE 500
LONG BEACH CA
90804-3328
US

V. Phone/Fax

Practice location:
  • Phone: 909-981-8383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BARRY STEVEN ALLSWANG
Title or Position: COO
Credential: MD
Phone: 562-299-5239