MEDICARE: DR. NIBERTO ANGEL MORENO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME105336	FL
2	208M00000X	Hospitalist Physician	ME105336	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629221528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIBERTO ANGEL MORENO M.D.

Provider Business Mailing Address
First Line	:	11220 SW 74TH CT
Second Line	:
City	:	PINECREST
State	:	FL
Zip	:	33156-4520
Country	:	US
Telephone Number	:	305-232-0235
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 NW 57TH CT STE 400
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3292
Country	:	US
Telephone Number	:	305-232-0235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2008
Last Update Date	:	05/05/2026

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