Healthcare Provider Details

I. General information

NPI: 1982154019
Provider Name (Legal Business Name): PROHEALTH PARTNERS A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 KATELLA AVE STE C
LOS ALAMITOS CA
90720-6409
US

IV. Provider business mailing address

3700 KATELLA AVE STE C
LOS ALAMITOS CA
90720-6409
US

V. Phone/Fax

Practice location:
  • Phone: 562-583-2250
  • Fax: 562-583-2254
Mailing address:
  • Phone: 562-583-2250
  • Fax: 562-583-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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