Provider Demographics
NPI:1972988491
Name:ERIC J. MEINHARDT, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ERIC J. MEINHARDT, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:MEINHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-275-1170
Mailing Address - Street 1:11645 WILSHIRE BLVD
Mailing Address - Street 2:1080
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11645 WILSHIRE BLVD
Practice Address - Street 2:1080
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1708
Practice Address - Country:US
Practice Address - Phone:310-275-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-26
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113988207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty