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General NPI Number Information
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NPI Number | 1902407711
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Entity Type | Organization
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Legal Business Name | PROHEALTH PARTNERS A MEDICAL GROUP
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 3700 KATELLA AVE STE D
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-6410
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Country | US
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Telephone | 562-855-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 5150 E PACIFIC COAST HWY STE 500
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City | LONG BEACH
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State | CA
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Zip | 90804-3328
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | BARRY STEVEN ALLSWANG
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Credential | MD
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Telephone | 562-299-5239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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