Provider Demographics
NPI:1306819412
Name:ARANA-DOMONDON, LADIE C (MD)
Entity Type:Individual
Prefix:DR
First Name:LADIE
Middle Name:C
Last Name:ARANA-DOMONDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LADIE
Other - Middle Name:C
Other - Last Name:ARANA-DOMONDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:118 7TH AVE SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-6803
Mailing Address - Country:US
Mailing Address - Phone:253-579-0067
Mailing Address - Fax:253-579-0068
Practice Address - Street 1:118 7TH AVE SW
Practice Address - Street 2:SUITE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-6803
Practice Address - Country:US
Practice Address - Phone:253-579-0067
Practice Address - Fax:253-579-0068
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO3401OtherMEDICARE OTHER-GROUP
WA110149928OtherMEDICARE OTHER-INDIVIDUAL
WA193400000XOtherTAXONOMY
WA8209611Medicaid
WAMD00034362OtherSTATE LICENSE
WA110149928OtherMEDICARE OTHER-INDIVIDUAL
WA8209611Medicaid