Provider Demographics
NPI:1174532006
Name:RENGIFO, ALBERTO (MD)
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:RENGIFO
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 1:292 CONSERVATION DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-2472
Mailing Address - Country:US
Mailing Address - Phone:954-217-1442
Mailing Address - Fax:954-884-8606
Practice Address - Street 1:2625 EXECUTIVE PARK DR STE 3
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3634
Practice Address - Country:US
Practice Address - Phone:954-217-1442
Practice Address - Fax:954-884-8606
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95009207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276703100Medicaid
I49433Medicare UPIN