1225788573 NPI number — PROHEALTH PARTNERS, A MEDICAL GROUP, INC.

Table of content: DR. TARA SANDERSON PSYD, MBA (NPI 1841469616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225788573 NPI number — PROHEALTH PARTNERS, A MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROHEALTH PARTNERS, A MEDICAL GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225788573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12555 GARDEN GROVE BLVD STE 306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92843-1904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-375-4142
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12555 GARDEN GROVE BLVD STE 306
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92843-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-375-4142
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2022

Additional Information

Authorized Official

Authorized Official Last Name:
FERRERA
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-299-5200

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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