Organization
CONCORDIA STAR MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LADIE CHRISTINE ARANA-DOMONDON M.D. (OWNER - CEO)
(253) 209-9009
Entity
Organization
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
261QM1300X
Multi-Specialty Clinic/Center
MD00034362
WA
261QP2300X
Primary Care Clinic/Center
Primary
MD00034362
WA
261QU0200X
Urgent Care Clinic/Center
MD00034362
WA
Other
Enumeration date
12/02/2011
Last updated
05/15/2015
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