Healthcare Provider Details

I. General information

NPI: 1245825900
Provider Name (Legal Business Name): PROHEALTH PARTNERS A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8212 ALONDRA BLVD
PARAMOUNT CA
90723-4402
US

IV. Provider business mailing address

8212 ALONDRA BLVD
PARAMOUNT CA
90723-4402
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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