Healthcare Provider Details

I. General information

NPI: 1033341680
Provider Name (Legal Business Name): PROHEALTH PARTNERS A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 E PACIFIC COAST HWY STE 500
LONG BEACH CA
90804-3328
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: 619-335-5259
  • Fax: 619-872-2498
Mailing address:
  • Phone: 619-335-5259
  • Fax: 619-872-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

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