Basic Information
Provider Information | |||||||||
NPI: | 1316924012 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RABOSTO | ||||||||
FirstName: | PABLO | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4725 N FEDERAL HWY | ||||||||
Address2: |   | ||||||||
City: | FORT LAUDERDALE | ||||||||
State: | FL | ||||||||
PostalCode: | 333084603 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9547865901 | ||||||||
FaxNumber: | 9547860129 | ||||||||
Practice Location | |||||||||
Address1: | 2011 NW 3RD AVE | ||||||||
Address2: |   | ||||||||
City: | POMPANO BEACH | ||||||||
State: | FL | ||||||||
PostalCode: | 330604800 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9547865901 | ||||||||
FaxNumber: | 9547860129 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/23/2005 | ||||||||
LastUpdateDate: | 03/26/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME108304 | FL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 200301040 | NC | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | 003611300 | 01 | FL | MEDICARE PROV ID | OTHER | 5902009 | 05 | NC |   | MEDICAID | 1316924012 | 01 |   | NPI | OTHER | BR8428597 | 01 |   | DEA | OTHER | 135T8 | 01 |   | BCBS | OTHER |