Individual
DR. LADIE C ARANA-DOMONDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
118 7TH AVE SW, SUITE A, PUYALLUP, WA 98371-6803
(253) 579-0067
(253) 579-0068
Mailing address
118 7TH AVE SW, SUITE A, PUYALLUP, WA 98371-6803
(253) 579-0067
(253) 579-0068
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00034362
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110149928
MEDICARE OTHER-INDIVIDUAL
WA
01
—
193400000X
TAXONOMY
WA
05
—
8209611
—
WA
01
—
CO3401
MEDICARE OTHER-GROUP
WA
01
—
MD00034362
STATE LICENSE
WA
Enumeration date
02/09/2006
Last updated
05/13/2015
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