| Entity Name: | PASQUAL BRACERO, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 29 Feb 1988 (37 years ago) |
| Document Number: | M69966 |
| FEI/EIN Number | 592873107 |
| Mail Address: | 12315 LAKE UNDERHILL ROAD, ORLANDO, FL, 32828 |
| Address: | 12315 LAKE UNDERHILL ROAD, ORLANDO, FL, 32828, US |
| ZIP code: | 32828 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942375936 | 2006-11-22 | 2020-08-22 | 2711 N ORANGE BLOSSOM TRL, KISSIMMEE, FL, 347441373, US | 2711 N ORANGE BLOSSOM TRL, KISSIMMEE, FL, 347441373, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-380-0302 |
| Fax | 4078709660 |
Authorized person
| Name | PASQUAL BRACERO |
| Role | PRESIDENT |
| Phone | 4073800302 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS GRP # ORLANDO OFFICE |
| Number | 384751 |
| State | FL |
| Issuer | AETNA HMO GROUP NUMBER |
| Number | 2446154 |
| State | FL |
| Issuer | BCBS GRP # KISSIMMEE OFC |
| Number | 38471A |
| State | CT |
| Issuer | AETNA PPO GROUP NUMBER |
| Number | 4425436 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRACERO PASQUAL | Agent | 12315 LAKE UNDERHILL ROAD, ORLANDO, FL, 32828 |
| Name | Role | Address |
|---|---|---|
| BRACERO PASQUAL | Director | 12315 LAKE UNDERHILL ROAD, ORLANDO, FL, 32828 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000105433 | ORLANDO CENTER FOR WOMEN'S HEALTH | EXPIRED | 2014-10-17 | 2019-12-31 | No data | 12315 LAKE UNDERHILL RD, ORLANDO, FL, 32828 |
| G12000006390 | ORLANDO CENTER FOR WOMEN'S HEALTH | EXPIRED | 2012-01-18 | 2017-12-31 | No data | 12315 LAKE UNDERHILL ROAD, ORLANDO, FL, 32828 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 1996-05-31 | PASQUAL BRACERO, M.D., P.A. | No data |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
