MEDICARE: PROHEALTH PARTNERS, A MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ZZZ51266Z	OTHER	CA	BLUE SHIELD GROUP NUMBER

General Provider Information

NPI Number	:	1134251192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROHEALTH PARTNERS, A MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	1045 ATLANTIC AVE
Second Line	:	SUITE 705
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 TERMINO AVE STE 214
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-2169
Country	:	US
Telephone Number	:	562-595-4718
Fax Number	:	562-591-7323

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BARRY ALLSWANG
Credential	:	MD
Telephone Number	:	562-299-5239

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	06/24/2020

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