Healthcare Provider Details

I. General information

NPI: 1912432477
Provider Name (Legal Business Name): PROHEALTH PARTNERS A MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR
NEWPORT BEACH CA
92663
US

IV. Provider business mailing address

5150 E PACIFIC COAST HWY SUITE 500
LONG BEACH CA
90804-3312
US

V. Phone/Fax

Practice location:
  • Phone: 562-299-5239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

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