Healthcare Provider Details

I. General information

NPI: 1326460023
Provider Name (Legal Business Name): PROHEALTH PARTNERS A MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4419 VAN NUYS BLVD STE 302
SHERMAN OAKS CA
91403-5726
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: 855-867-5551
  • Fax: 562-506-0053
Mailing address:
  • Phone:
  • Fax:

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 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