Provider Demographics
NPI:1801820543
Name:BERDASCO PAZ, AIDA R (MD)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:R
Last Name:BERDASCO PAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6675 WESTWOOD BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:425 S PARSONS AVE STE 102
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5290
Practice Address - Country:US
Practice Address - Phone:813-445-8033
Practice Address - Fax:813-378-8361
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLACN855208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
88052Medicare ID - Type Unspecified
G40982Medicare UPIN