Healthcare Provider Details

I. General information

NPI: 1023680279
Provider Name (Legal Business Name): PROHEALTH PARTNERS A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 HAVEN AVE STE 100
RANCHO CUCAMONGA CA
91730-3070
US

IV. Provider business mailing address

8008 HAVEN AVE STE 100
RANCHO CUCAMONGA CA
91730-3070
US

V. Phone/Fax

Practice location:
  • Phone: 909-483-1236
  • Fax: 909-344-3910
Mailing address:
  • Phone: 909-483-1236
  • Fax: 909-344-3910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

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