MEDICARE: OCTAVIO B CARRENO MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	ME0014312	FL

General Provider Information

NPI Number	:	1568494805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCTAVIO B CARRENO MD PA

Provider Business Mailing Address
First Line	:	3661 SOUTH MIAMI AVE
Second Line	:	STE 601
City	:	MIAMI
State	:	FL
Zip	:	33133-4248
Country	:	US
Telephone Number	:	305-854-4555
Fax Number	:	305-854-4511

Provider Business Practice Location Address
First Line	:	3661 SOUTH MIAMI AVE
Second Line	:	STE 601
City	:	MIAMI
State	:	FL
Zip	:	33133-4248
Country	:	US
Telephone Number	:	305-854-4555
Fax Number	:	305-854-4511

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OCTAVIO B CARRENO
Credential	:	MD PA
Telephone Number	:	305-854-4555

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	08/22/2020

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