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General NPI Number Information
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NPI Number | 1356500854
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Entity Type | Individual
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Provider Name | PABLO A RENGIFO-MORENO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 1625 SE 3RD AVE STE 620
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2521
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Country | US
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Telephone | 954-788-5000
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Fax | 954-888-3505
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Provider Business Mailing Address
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Address Line | 1608 SE 3RD AVE FL 3
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2564
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Country | US
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Telephone | 954-788-5000
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Fax | 954-888-3505
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | ME138838
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 076669
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | AS 4148501 E-64
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License Number State | MA
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