Healthcare Provider Details

I. General information

NPI: 1154862241
Provider Name (Legal Business Name): PROHEALTH PARTNERS A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3742 KATELLA AVE STE 303
LOS ALAMITOS CA
90720-3172
US

IV. Provider business mailing address

3742 KATELLA AVE STE 303
LOS ALAMITOS CA
90720-3172
US

V. Phone/Fax

Practice location:
  • Phone: 562-296-8050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

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