Basic Information
| Provider Information | |||||||||
| NPI: | 1356474852 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROHEALTH PARTNERS, A MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5150 E PACIFIC COAST HWY STE 500 | ||||||||
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| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908043328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622995200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1045 ATLANTIC AVE STE 812 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908133424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624355353 | ||||||||
| FaxNumber: | 5624915404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 05/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | ALLSWANG | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | STEVEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5622995200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.