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General NPI Number Information
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NPI Number | 1003827809
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Entity Type | Individual
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Provider Name | PASQUAL BRACERO M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 12315 LAKE UNDERHILL RD STE A
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City | ORLANDO
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State | FL
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Zip | 32828-4507
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Country | US
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Telephone | 407-380-0302
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Fax | 407-380-5127
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Provider Business Mailing Address
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Address Line | 3300 S FISKE BLVD BLDG A
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City | ROCKLEDGE
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State | FL
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Zip | 32955-4306
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Country | US
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Telephone | 407-380-0302
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | ME49965
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License Number State | FL
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