1306819412 NPI number — DR. LADIE C ARANA-DOMONDON MD

Table of content: DR. LADIE C ARANA-DOMONDON MD (NPI 1306819412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306819412 NPI number — DR. LADIE C ARANA-DOMONDON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARANA-DOMONDON
Provider First Name:
LADIE
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARANA-DOMONDON
Provider Other First Name:
LADIE
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1306819412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 7TH AVE SW
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98371-6803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-579-0067
Provider Business Mailing Address Fax Number:
253-579-0068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 7TH AVE SW
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98371-6803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-579-0067
Provider Business Practice Location Address Fax Number:
253-579-0068
Provider Enumeration Date:
02/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD00034362 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CO3401 . This is a "MEDICARE OTHER-GROUP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 110149928 . This is a "MEDICARE OTHER-INDIVIDUAL" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 193400000X . This is a "TAXONOMY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8209611 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MD00034362 . This is a "STATE LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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