Healthcare Provider Details

I. General information

NPI: 1922495076
Provider Name (Legal Business Name): PROHEALTH PARTNERS A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7643 ATLANTIC AVE
CUDAHY CA
90201
US

IV. Provider business mailing address

7643 ATLANTIC AVE
CUDAHY CA
90201-5019
US

V. Phone/Fax

Practice location:
  • Phone: 323-771-1713
  • Fax: 323-562-1302
Mailing address:
  • Phone: 323-771-1713
  • Fax: 323-562-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: BARRY STEVEN ALLSWANG
Title or Position: PRESIDENT
Credential: MD
Phone: 562-299-5200