Provider Demographics
NPI:1134101827
Name:BAGO, MARIACLARA E (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIACLARA
Middle Name:E
Last Name:BAGO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1037 S STATE ROAD 7
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6138
Mailing Address - Country:US
Mailing Address - Phone:561-798-3030
Mailing Address - Fax:561-798-8242
Practice Address - Street 1:1037 S STATE ROAD 7
Practice Address - Street 2:SUITE 211
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6138
Practice Address - Country:US
Practice Address - Phone:561-798-3030
Practice Address - Fax:561-798-8242
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0S8749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I06448Medicare UPIN
FL379932Medicare ID - Type Unspecified