Healthcare Provider Details

I. General information

NPI: 1760064109
Provider Name (Legal Business Name): REENA BASTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S 320TH ST
FEDERAL WAY WA
98003-5200
US

IV. Provider business mailing address

301 S 320TH ST
FEDERAL WAY WA
98003-5200
US

V. Phone/Fax

Practice location:
  • Phone: 253-874-7000
  • Fax: 866-559-3952
Mailing address:
  • Phone: 253-874-7000
  • Fax: 866-559-3952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD.MD.70113851
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: