Provider Demographics
NPI:1770102899
Name:MENINNO, ERICA T (MD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:T
Last Name:MENINNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2621 S 3270 W
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-1119
Mailing Address - Country:US
Mailing Address - Phone:852-612-6143
Mailing Address - Fax:877-497-4661
Practice Address - Street 1:220 W 7200 S STE A
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1043
Practice Address - Country:US
Practice Address - Phone:801-566-5494
Practice Address - Fax:877-497-4661
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT13214887-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine