Healthcare Provider Details

I. General information

NPI: 1265982359
Provider Name (Legal Business Name): PROHEALTH PARTNERS A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 ELM AVE SUITE 100
LONG BEACH CA
90813-3264
US

IV. Provider business mailing address

1040 ELM AVE STE 100
LONG BEACH CA
90813-3265
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-4444
  • Fax:
Mailing address:
  • Phone: 562-591-4444
  • Fax: 562-436-7350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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