Healthcare Provider Details

I. General information

NPI: 1477685436
Provider Name (Legal Business Name): PROHEALTH PARTNERS, A MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 WOODRUFF AVE STE 202
LONG BEACH CA
90808-2149
US

IV. Provider business mailing address

3840 WOODRUFF AVE STE 202
LONG BEACH CA
90808-2149
US

V. Phone/Fax

Practice location:
  • Phone: 562-296-5528
  • Fax: 562-296-8770
Mailing address:
  • Phone: 562-296-5528
  • Fax: 562-296-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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