NPIMap

Organization Active NPI

Concordia Star Medical LLC

  • Primary Care Clinic/Center
  • Puyallup, WA
National Provider Identifier
1790163491
Registry record updated May 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CONCORDIA STAR MEDICAL LLC
Practice address
118 7TH Ave SW
Suite a
Puyallup, WA 98371-6803
Phone
(253) 579-0067
Fax
(253) 579-0068
NPI assigned
May 13, 2015
Last updated
May 13, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ladie C Arana-Domondon, M.D.NPI 1306819412
Title
Owner/Ceo
Phone
(253) 579-0067

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

118 7TH Ave SW
Suite a
Puyallup, WA 98371-6803

Mailing address

118 7TH Ave SW
Suite a
Puyallup, WA 98371-6803
Phone (253) 579-0067

National Provider Directory

National Provider Directory

Locations

118 7th Ave SW
Ste A
Puyallup, WA 98371
Phone (253) 579-0067

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431475200000",
    "number": "1790163491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 7TH AVE SW",
            "address_2": "SUITE A",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983716803",
            "telephone_number": "253-579-0067",
            "fax_number": "253-579-0068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 7TH AVE SW",
            "address_2": "SUITE A",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983716803",
            "telephone_number": "253-579-0067",
            "fax_number": "253-579-0068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCORDIA STAR MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-13",
        "last_updated": "2015-05-13",
        "status": "A",
        "authorized_official_last_name": "ARANA-DOMONDON",
        "authorized_official_first_name": "LADIE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "253-579-0067",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.