Provider Demographics
NPI:1457774879
Name:HEALTHNET MEDICAL, LLC
Entity Type:Organization
Organization Name:HEALTHNET MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:EBRAN-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-375-0138
Mailing Address - Street 1:8660 W FLAGLER ST STE 111
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2035
Mailing Address - Country:US
Mailing Address - Phone:786-375-0138
Mailing Address - Fax:305-901-1716
Practice Address - Street 1:8660 W FLAGLER ST STE 111
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2035
Practice Address - Country:US
Practice Address - Phone:786-375-0138
Practice Address - Fax:305-901-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHK796ZMedicare PIN