Provider Demographics
NPI:1376652479
Name:BERETTA, ALDO R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALDO
Middle Name:R
Last Name:BERETTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24231 WALDEN CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-5012
Mailing Address - Country:US
Mailing Address - Phone:239-390-2174
Mailing Address - Fax:239-390-2486
Practice Address - Street 1:24231 WALDEN CENTER DR STE 201
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-5012
Practice Address - Country:US
Practice Address - Phone:239-390-2174
Practice Address - Fax:239-390-2486
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78272174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593667470OtherTAX ID
FL51814Medicare ID - Type Unspecified