NPI Code Detail JSON Logo

1356500854 NPI number — PABLO A RENGIFO-MORENO M.D.

NPI Number: 1356500854
Health Care Provider/Practitioner: PABLO A RENGIFO-MORENO M.D.

Information about “1356500854” NPI (PABLO A RENGIFO-MORENO M.D.) exists in 1356500854 in HTML format HTML  |  1356500854 in plain Text format TXT  |  1356500854 in PDF (Portable Document Format) PDF  |  1356500854 in an XML format XML  formats.

NPI Number : 1356500854 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1356500854",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RENGIFO-MORENO",
    "FirstName": "PABLO",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1608 SE 3RD AVE FL 3",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT LAUDERDALE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33316-2564",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-788-5000",
    "MailingAddressFaxNumber": "954-888-3505",
    "FirstLinePracticeLocationAddress": "1625 SE 3RD AVE STE 620",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT LAUDERDALE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33316-2521",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-788-5000",
    "PracticeLocationAddressFaxNumber": "954-888-3505",
    "EnumerationDate": "06/09/2008",
    "LastUpdateDate": "10/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207RI0011X",
          "TaxonomyName": "Interventional Cardiology Physician",
          "LicenseNumber": "ME138838",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207RC0000X",
          "TaxonomyName": "Cardiovascular Disease Physician",
          "LicenseNumber": "076669",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "AS 4148501 E-64",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.