Healthcare Provider Details

I. General information

NPI: 1598898462
Provider Name (Legal Business Name): PROHEALTH PARTNERS, A MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 TERMINO AVE STE G18
LONG BEACH CA
90804-2169
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: 562-432-9911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BARRY ALLSWANG
Title or Position: COO
Credential: MD
Phone: 562-299-5239