Healthcare Provider Details

I. General information

NPI: 1336641992
Provider Name (Legal Business Name): PROHEALTH PARTNERS A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR STE 165
FOOTHILL RANCH CA
92610-2845
US

IV. Provider business mailing address

26700 TOWNE CENTRE DR STE 165
FOOTHILL RANCH CA
92610-2845
US

V. Phone/Fax

Practice location:
  • Phone: 949-519-0020
  • Fax: 949-519-0040
Mailing address:
  • Phone: 949-519-0020
  • Fax: 949-519-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

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