Healthcare Provider Details

I. General information

NPI: 1134081557
Provider Name (Legal Business Name): PEDRO TOMAS-DOMINGO LSWAIC, MCHES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 19TH AVE E
SEATTLE WA
98112-4007
US

IV. Provider business mailing address

500 19TH AVE E
SEATTLE WA
98112-4007
US

V. Phone/Fax

Practice location:
  • Phone: 206-299-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberSC70011034
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number25798
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC70011034
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: