Provider Demographics
NPI:1568494805
Name:OCTAVIO B CARRENO MD PA
Entity Type:Organization
Organization Name:OCTAVIO B CARRENO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARRENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:305-854-4555
Mailing Address - Street 1:3661 SOUTH MIAMI AVE
Mailing Address - Street 2:STE 601
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4248
Mailing Address - Country:US
Mailing Address - Phone:305-854-4555
Mailing Address - Fax:305-854-4511
Practice Address - Street 1:3661 SOUTH MIAMI AVE
Practice Address - Street 2:STE 601
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4248
Practice Address - Country:US
Practice Address - Phone:305-854-4555
Practice Address - Fax:305-854-4511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0014312207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91220Medicare ID - Type Unspecified
FL40481Medicare ID - Type Unspecified
D59546Medicare UPIN