| Entrust Medical Group Inc | |
|
14411 Commerce Way Ste 300 Miami Lakes FL 33016-1532 | |
| (786) 803-8687 | |
| Not Available |
| Full Name | Entrust Medical Group Inc |
|---|---|
| Speciality | General Practice |
| Location | 14411 Commerce Way Ste 300, Miami Lakes, Florida |
| Authorized Official Name and Position | Dianelys San Roman Parrado (PRESIDENT) |
| Authorized Official Contact | 7868038687 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Entrust Medical Group Inc 14411 Commerce Way Ste 300 Miami Lakes FL 33016-1532 Ph: (786) 803-8687 | Entrust Medical Group Inc 14411 Commerce Way Ste 300 Miami Lakes FL 33016-1532 Ph: (786) 803-8687 |
| NPI Number | 1275363236 |
|---|---|
| Provider Enumeration Date | 08/05/2024 |
| Last Update Date | 02/19/2025 |
| Medicare PECOS PAC ID | 2062940786 |
|---|---|
| Medicare Enrollment ID | O20250109000406 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275363236 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Hector Conrad Rasco |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1386873412 PECOS PAC ID: 9133263312 Enrollment ID: I20201204000467 |
| Provider Name | Dianelys San Roman Parrado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508523275 PECOS PAC ID: 8325429335 Enrollment ID: I20220722000640 |
| Provider Name | Milenis Lopez Leon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417537010 PECOS PAC ID: 4486015716 Enrollment ID: I20230802001700 |
| Provider Name | Madeleidis Lopez Leon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265013981 PECOS PAC ID: 4486015674 Enrollment ID: I20230803004115 |
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