Provider Demographics
NPI:1891961421
Name:BACCINI JAUREGUI, CLARA (MD)
Entity type:Individual
Prefix:DR
First Name:CLARA
Middle Name:
Last Name:BACCINI JAUREGUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13290 KEYSTONE TER
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2254
Mailing Address - Country:US
Mailing Address - Phone:305-570-2225
Mailing Address - Fax:305-899-0411
Practice Address - Street 1:4791 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3938
Practice Address - Country:US
Practice Address - Phone:305-570-2225
Practice Address - Fax:305-899-0411
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME107797207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022-462-200Medicaid
FL004789300Medicaid