1003827809 NPI number — PASQUAL BRACERO M.D.

Table of content: PASQUAL BRACERO M.D. (NPI 1003827809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003827809 NPI number — PASQUAL BRACERO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRACERO
Provider First Name:
PASQUAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003827809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 S FISKE BLVD BLDG A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32955-4306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-380-0302
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12315 LAKE UNDERHILL RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32828-4507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-380-0302
Provider Business Practice Location Address Fax Number:
407-380-5127
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X , with the licence number:  ME49965 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 205242 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 261-853-201 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 045-914-300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 261-853-200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: OA173 . This is a "MEDICARE HF" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2446154 . This is a "AETNA HMO - GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P1830864 . This is a "OXFORD HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 38471 . This is a "BCBS - GROUP LOC. 1" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4278951 . This is a "AETNA PPO - INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4425436 . This is a "AETNA PPO - GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 922260 . This is a "AETNA - INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 03928 . This is a "BCBS - INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 59-2873107 - D . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0700168 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 38471A . This is a "BCBS - GROUP LOC. 2" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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