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	207RB0002X	Obesity Medicine (Internal Medicine) Physician
2	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1598898462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROHEALTH PARTNERS, A MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	5150 E PACIFIC COAST HWY STE 500
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3328
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 TERMINO AVE STE G18
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-2169
Country	:	US
Telephone Number	:	562-432-9911
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	09/25/2020

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