Wanda Ivelisse Pacheco, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

10070 Issued in PR

Practice address

Assmca Centro de Detoxificacion
Ave.Tito Castro Interior
Ponce, PR 00732-7321

Phone

(787) 840-6935

NPI assigned

Apr 24, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Saint Lukes Memorial Hospital Inc

  • General Acute Care Hospital
  • Ponce, PR
  • NPI 1841295557
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285852061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 418",
            "city": "SABANA GRANDE",
            "state": "PR",
            "postal_code": "006370418",
            "telephone_number": "787-833-2899",
            "fax_number": "787-833-2899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ASSMCA CENTRO DE DETOXIFICACION",
            "address_2": "AVE.TITO CASTRO INTERIOR",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007327321",
            "telephone_number": "787-840-6935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACHECO",
        "first_name": "WANDA",
        "middle_name": "IVELISSE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "10070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Biankinette Pacheco Miranda
• Wanda Pacheco Ramos, RN
• Elvin Juan Pacheco, MD
• Margie Berenice Pacheco, CPL
• Mayra Pacheco, CRNA
• Miriam M Padilla Diaz, MD
• Angeles Lourrain Padilla Zapata
• Alondra Padilla
• Isamar Padilla
• Marianela Padilla, MPT, PT

• General Practice Physician in Ponce, PR
• Providers in Ponce, PR by specialty
• General Practice Physician in Puerto Rico

• 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.

Verify at the official NPI Registry.