| Entity Name: | CLARA BACCINI, MD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 04 Aug 2011 (14 years ago) |
| Document Number: | P11000070239 |
| FEI/EIN Number | 45-2991330 |
| Mail Address: | 13290 KEYSTONE TER, NORTH MIAMI, FL 33181 |
| Address: | 4791 W 4th Ave, Hialeah, FL 33012 |
| ZIP code: | 33012 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033492723 | 2011-09-20 | 2022-06-29 | 13290 KEYSTONE TER, NORTH MIAMI, FL, 331812254, US | 4791 W 4TH AVE, HIALEAH, FL, 330123938, US | |||||||||||||||||||||||||
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| Phone | +1 305-570-2225 |
| Fax | 3058990411 |
Authorized person
| Name | CLARA BACCINI JAUREGUI |
| Role | PRESIDENT |
| Phone | 3055702225 |
Taxonomy
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| License Number | ME107797 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022-462-200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BACCINI, CLARA MD | Agent | 4791 West 4th Ave, Hialeah, FL 33012 |
| Name | Role | Address |
|---|---|---|
| BACCINI, CLARA | Manager | 13290 KEYSTONE TER, NORTH MIAMI, FL 33181 |
| Name | Role | Address |
|---|---|---|
| BACCINI, CLARA | Director | 13290 KEYSTONE TER, NORTH MIAMI, FL 33181 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-27 | 4791 West 4th Ave, Hialeah, FL 33012 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-06-29 | 4791 W 4th Ave, Hialeah, FL 33012 | No data |
| CHANGE OF MAILING ADDRESS | 2018-02-15 | 4791 W 4th Ave, Hialeah, FL 33012 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-19 |
| ANNUAL REPORT | 2024-01-08 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-03-02 |
| ANNUAL REPORT | 2021-01-19 |
| ANNUAL REPORT | 2020-04-28 |
| ANNUAL REPORT | 2019-02-19 |
| ANNUAL REPORT | 2018-05-01 |
| ANNUAL REPORT | 2017-03-15 |
| ANNUAL REPORT | 2016-04-21 |
Date of last update: 23 Feb 2025
Sources: Florida Department of State
