Healthcare Provider Details

I. General information

NPI: 1972117984
Provider Name (Legal Business Name): LENNY MARITZA RENGIFO HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E BROWARD BLVD STE 301-4
FORT LAUDERDALE FL
33301-2046
US

IV. Provider business mailing address

5085 NW 7TH ST APT 605
MIAMI FL
33126-3454
US

V. Phone/Fax

Practice location:
  • Phone: 786-912-0609
  • Fax:
Mailing address:
  • Phone: 954-901-8263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC219081
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4186
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA75770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: