Provider Demographics
NPI:1912987405
Name:URIBASTERRA, PABLO E (MD)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:E
Last Name:URIBASTERRA
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 1:301 NW 179TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2817
Mailing Address - Country:US
Mailing Address - Phone:954-447-1446
Mailing Address - Fax:954-241-4147
Practice Address - Street 1:301 NW 179TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029
Practice Address - Country:US
Practice Address - Phone:954-447-1446
Practice Address - Fax:954-241-4147
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75925207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254472500Medicaid
43661QMedicare PIN
G40691Medicare UPIN