Healthcare Provider Details

I. General information

NPI: 1922673300
Provider Name (Legal Business Name): ELIDIA COLMENARES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date: 07/11/2025
Reactivation Date: 08/11/2025

III. Provider practice location address

723 SW 10TH ST
RENTON WA
98057-5223
US

IV. Provider business mailing address

3817 S D ST
TACOMA WA
98418
US

V. Phone/Fax

Practice location:
  • Phone: 206-461-4880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: