Provider Demographics
NPI:1174519052
Name:MENINA, ERICA (MD)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:MENINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1300
Mailing Address - Country:US
Mailing Address - Phone:985-384-2430
Mailing Address - Fax:
Practice Address - Street 1:1055 DAVID DR
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1300
Practice Address - Country:US
Practice Address - Phone:985-384-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.026047208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1054887Medicaid
4J783Medicare ID - Type Unspecified
LA1054887Medicaid