Provider Demographics
NPI:1699794883
Name:HEALTHNET PLUS
Entity type:Organization
Organization Name:HEALTHNET PLUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:IQTADARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-558-0131
Mailing Address - Street 1:1745 W 17TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2379
Mailing Address - Country:US
Mailing Address - Phone:714-558-0131
Mailing Address - Fax:714-558-0262
Practice Address - Street 1:1745 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2378
Practice Address - Country:US
Practice Address - Phone:714-558-0131
Practice Address - Fax:714-558-0262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY470043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA470040OtherMEDICAL
CAPHA470040OtherMEDICAL
CAPHA470040OtherMEDICAL