Provider Demographics
NPI:1235258351
Name:MENACHOF, LOUIS W (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:W
Last Name:MENACHOF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15620 HEALDSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-9617
Mailing Address - Country:US
Mailing Address - Phone:707-473-4531
Mailing Address - Fax:707-473-4559
Practice Address - Street 1:3324 CHANATE RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-1708
Practice Address - Country:US
Practice Address - Phone:707-576-4659
Practice Address - Fax:707-576-4087
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC22839208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics