Active NPI
Mildred Nereida Pancorbo, LCDA
- Pharmacist
- Mayaguez, PR
National Provider Identifier
1124174750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 3425
- Practice address
- 21 Calle Zafiro
Vista Verde
Mayaguez, PR 00682-2519 - Phone
- (787) 646-8870
- Fax
- (787) 832-2186
- NPI assigned
- Jan 26, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 3425 | PR | Primary |
Addresses
Primary practice location
21 Calle Zafiro
Vista Verde
Mayaguez, PR 00682-2519
Mailing address
21 Calle Zafiro
Vista Verde
Mayaguez, PR 00682-2519
Phone (787) 646-8870
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3425 | PR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124174750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 CALLE ZAFIRO",
"address_2": "VISTA VERDE",
"city": "MAYAGUEZ",
"state": "PR",
"postal_code": "006822519",
"telephone_number": "787-646-8870",
"fax_number": "787-832-2186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 CALLE ZAFIRO",
"address_2": "VISTA VERDE",
"city": "MAYAGUEZ",
"state": "PR",
"postal_code": "006822519",
"telephone_number": "787-646-8870",
"fax_number": "787-832-2186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANCORBO",
"first_name": "MILDRED",
"middle_name": "NEREIDA",
"name_prefix": "Mrs.",
"credential": "LCDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PR",
"license": "3425",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mayaguez, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.