Healthcare Provider Details

I. General information

NPI: 1356874408
Provider Name (Legal Business Name): LIZA M DOMINGUEZ-COLMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIZA M DOMINGUEZ COLMAN MD

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

2607 WESTERN AVE APT 208
SEATTLE WA
98121-1332
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-2007
  • Fax:
Mailing address:
  • Phone: 312-428-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD61165480
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: