Provider Demographics
NPI:1629221528
Name:MORENO, NIBERTO ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NIBERTO
Middle Name:ANGEL
Last Name:MORENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11220 SW 74TH CT
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-4520
Mailing Address - Country:US
Mailing Address - Phone:305-232-0235
Mailing Address - Fax:
Practice Address - Street 1:1000 NW 57TH CT STE 400
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3292
Practice Address - Country:US
Practice Address - Phone:305-232-0235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105336207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCJ758WMedicare PIN
FLCJ758ZMedicare PIN