Healthcare Provider Details

I. General information

NPI: 1467584441
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: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3772 KATELLA AVE STE 101
LOS ALAMITOS CA
90720-6420
US

IV. Provider business mailing address

3772 KATELLA AVE STE 101 SUITE 200
LOS ALAMITOS CA
90720-6420
US

V. Phone/Fax

Practice location:
  • Phone: 562-594-8853
  • Fax: 562-391-1860
Mailing address:
  • Phone: 562-594-8853
  • Fax: 562-391-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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