Provider Demographics
NPI:1083753701
Name:DIDOMENICO, BETH (ND)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:DIDOMENICO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S 336TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6311
Mailing Address - Country:US
Mailing Address - Phone:253-942-3301
Mailing Address - Fax:253-815-8805
Practice Address - Street 1:900 S 336TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6311
Practice Address - Country:US
Practice Address - Phone:253-942-3301
Practice Address - Fax:253-815-8805
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000861175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath