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General NPI Number Information
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NPI Number | 1033492723
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Entity Type | Organization
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Legal Business Name | CLARA BACCINI, MD, PA
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Dates
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Enumeration Date | 09/20/2011
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 4791 W 4TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-3938
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Country | US
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Telephone | 305-570-2225
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Fax | 305-899-0411
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Provider Business Mailing Address
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Address Line | 13290 KEYSTONE TER
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City | NORTH MIAMI
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State | FL
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Zip | 33181-2254
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Country | US
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Telephone | 305-570-2225
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Fax | 305-899-0411
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLARA BACCINI JAUREGUI
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Credential |
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Telephone | 305-570-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME107797
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License Number State | FL
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