Provider Demographics
NPI:1790707073
Name:HAWKES, STEVEN (PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:HAWKES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 894830
Mailing Address - Street 2:LOCK BOX 4830
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90189-4830
Mailing Address - Country:US
Mailing Address - Phone:702-360-2100
Mailing Address - Fax:909-557-1924
Practice Address - Street 1:6460 MEDICAL CENTER ST STE 350
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2423
Practice Address - Country:US
Practice Address - Phone:702-255-6647
Practice Address - Fax:702-933-1444
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P54258Medicare UPIN
NVDC887ZMedicare PIN
NV100511Medicare PIN