Healthcare Provider Details

I. General information

NPI: 1427480987
Provider Name (Legal Business Name): PROHEALTH PARTNERS A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 W CARSON ST
TORRANCE CA
90502-2006
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: 310-222-2773
  • Fax: 310-782-9652
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

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