Healthcare Provider Details

I. General information

NPI: 1396632378
Provider Name (Legal Business Name): CAMILA WENCZENOVICZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 06/21/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-3306
  • Fax: 513-751-8638
Mailing address:
  • Phone: 513-862-3306
  • Fax: 513-751-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.258621
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: