Provider Demographics
NPI:1972923647
Name:HEALTHNET MEDICAL, LLC
Entity Type:Organization
Organization Name:HEALTHNET MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-667-8007
Mailing Address - Street 1:8660 W FLAGLER ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2031
Mailing Address - Country:US
Mailing Address - Phone:305-753-9075
Mailing Address - Fax:305-901-1716
Practice Address - Street 1:8660 W FLAGLER ST
Practice Address - Street 2:SUITE 111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2031
Practice Address - Country:US
Practice Address - Phone:305-753-9075
Practice Address - Fax:305-901-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty