| Concordia Star Medical Llc | |
|
118 7th Ave Sw Suite A Puyallup WA 98371-6803 | |
| (253) 579-0067 | |
| (253) 579-0068 |
| Full Name | Concordia Star Medical Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 118 7th Ave Sw, Puyallup, Washington |
| Authorized Official Name and Position | Ladie Christine Arana-domondon (OWNER - CEO) |
| Authorized Official Contact | 2532099009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Concordia Star Medical Llc 118 7th Ave Sw Suite A Puyallup WA 98371-6803 Ph: (253) 579-0067 | Concordia Star Medical Llc 118 7th Ave Sw Suite A Puyallup WA 98371-6803 Ph: (253) 579-0067 |
| NPI Number | 1508134792 |
|---|---|
| Provider Enumeration Date | 12/02/2011 |
| Last Update Date | 05/15/2015 |
| Medicare PECOS PAC ID | 5597928549 |
|---|---|
| Medicare Enrollment ID | O20120531000537 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508134792 | NPI | - | NPPES |
| Provider Name | Ladie C Arana-domondon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306819412 PECOS PAC ID: 3779473285 Enrollment ID: I20100922000828 |
| Provider Name | Marvin P Tolentino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952646424 PECOS PAC ID: 4880848183 Enrollment ID: I20130214000546 |
| Provider Name | Claire Marie Harvey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619355245 PECOS PAC ID: 8224343033 Enrollment ID: I20150821013912 |
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