Provider Demographics
NPI:1356500854
Name:RENGIFO-MORENO, PABLO A (MD)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:A
Last Name:RENGIFO-MORENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 SE 3RD AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2564
Mailing Address - Country:US
Mailing Address - Phone:954-788-5000
Mailing Address - Fax:954-888-3505
Practice Address - Street 1:1625 SE 3RD AVE STE 620
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-788-5000
Practice Address - Fax:954-888-3505
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138838207RI0011X
GA076669207RC0000X
MAAS 4148501 E-64207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine