Provider Demographics
NPI:1659496818
Name:MONICA, MONICA LOU (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:LOU
Last Name:MONICA
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 1:120 MEADOWCREST ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5255
Mailing Address - Country:US
Mailing Address - Phone:504-391-7560
Mailing Address - Fax:504-394-2269
Practice Address - Street 1:120 MEADOWCREST ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5255
Practice Address - Country:US
Practice Address - Phone:504-391-7560
Practice Address - Fax:504-394-2269
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD015715174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist