Healthcare Provider Details

I. General information

NPI: 1003827809
Provider Name (Legal Business Name): PASQUAL BRACERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12315 LAKE UNDERHILL RD STE A
ORLANDO FL
32828-4507
US

IV. Provider business mailing address

3300 S FISKE BLVD BLDG A
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 407-380-0302
  • Fax: 407-380-5127
Mailing address:
  • Phone: 407-380-0302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME49965
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: