Provider Demographics
NPI:1417622291
Name:HAWAYEK DE PAZ, ESTEFANIA CRISTINA
Entity Type:Individual
Prefix:
First Name:ESTEFANIA
Middle Name:CRISTINA
Last Name:HAWAYEK DE PAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 WALNUT ST APT 402
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-5806
Mailing Address - Country:US
Mailing Address - Phone:787-244-6627
Mailing Address - Fax:
Practice Address - Street 1:48 APPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5294
Practice Address - Country:US
Practice Address - Phone:787-244-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2305498Medicaid