Provider Demographics
NPI:1639125107
Name:PAZMINO-VERA, MILDRED E (MD)
Entity Type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:E
Last Name:PAZMINO-VERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10051 5TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:813-930-6360
Practice Address - Street 1:3675 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2783
Practice Address - Country:US
Practice Address - Phone:813-915-2000
Practice Address - Fax:813-930-6360
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080097670OtherRAILROAD MEDICARE NUMBER
FL263816900Medicaid
FL080097670OtherRAILROAD MEDICARE NUMBER
FL27443XMedicare PIN
F82466Medicare UPIN