Healthcare Provider Details

I. General information

NPI: 1497173603
Provider Name (Legal Business Name): MONIKA LEAH DIETRICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TULANE AVE SL-37
NEW ORLEANS LA
70112-2632
US

IV. Provider business mailing address

1430 TULANE AVE SL-37
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5458
  • Fax: 504-988-6808
Mailing address:
  • Phone: 504-988-5458
  • Fax: 504-988-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number306473
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number306473
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: