Healthcare Provider Details

I. General information

NPI: 1891961421
Provider Name (Legal Business Name): CLARA BACCINI JAUREGUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2008
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4791 W 4TH AVE
HIALEAH FL
33012-3938
US

IV. Provider business mailing address

13290 KEYSTONE TER
NORTH MIAMI FL
33181-2254
US

V. Phone/Fax

Practice location:
  • Phone: 305-570-2225
  • Fax: 305-899-0411
Mailing address:
  • Phone: 305-570-2225
  • Fax: 305-899-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME107797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: