Provider Demographics
NPI:1518960962
Name:ECHENIQUE, VICTOR MANUEL (MD)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:MANUEL
Last Name:ECHENIQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:1051 GAUSE BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2988
Practice Address - Country:US
Practice Address - Phone:985-641-7577
Practice Address - Fax:985-643-0826
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045491207RC0000X
LA017016207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1381471Medicaid
060018917OtherRAILROAD MEDICARE
MS00019078Medicaid
MS00019078Medicaid