Healthcare Provider Details

I. General information

NPI: 1629221528
Provider Name (Legal Business Name): NIBERTO ANGEL MORENO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NW 57TH CT STE 400
MIAMI FL
33126-3292
US

IV. Provider business mailing address

11220 SW 74TH CT
PINECREST FL
33156-4520
US

V. Phone/Fax

Practice location:
  • Phone: 305-232-0235
  • Fax:
Mailing address:
  • Phone: 305-232-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME105336
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME105336
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: