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General NPI Number Information
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NPI Number | 1306819412
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Entity Type | Individual
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Provider Name | LADIE C ARANA-DOMONDON MD
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Gender | Female
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 118 7TH AVE SW SUITE A
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City | PUYALLUP
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State | WA
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Zip | 98371-6803
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Country | US
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Telephone | 253-579-0067
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Fax | 253-579-0068
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Provider Business Mailing Address
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Address Line | 118 7TH AVE SW SUITE A
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City | PUYALLUP
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State | WA
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Zip | 98371-6803
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Country | US
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Telephone | 253-579-0067
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Fax | 253-579-0068
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD00034362
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License Number State | WA
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