Healthcare Provider Details

I. General information

NPI: 1295625168
Provider Name (Legal Business Name): MADISON GABRIELLA MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8811 S TACOMA WAY STE 204&206
LAKEWOOD WA
98499-4595
US

IV. Provider business mailing address

7307 N 23RD ST
TACOMA WA
98406-1606
US

V. Phone/Fax

Practice location:
  • Phone: 425-217-1140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: