Provider Demographics
NPI:1033883574
Name:ENT GROUP, LLC
Entity Type:Organization
Organization Name:ENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-450-1757
Mailing Address - Street 1:2400 SW 69TH AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2947
Mailing Address - Country:US
Mailing Address - Phone:305-450-1757
Mailing Address - Fax:305-265-4844
Practice Address - Street 1:2400 SW 69TH AVE STE 140
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2947
Practice Address - Country:US
Practice Address - Phone:305-450-1757
Practice Address - Fax:305-265-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-08
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty