Healthcare Provider Details

I. General information

NPI: 1699602565
Provider Name (Legal Business Name): GILVANI DATINGINOO REYES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33480 13TH PL S
FEDERAL WAY WA
98003-6357
US

IV. Provider business mailing address

33480 13TH PL S
FEDERAL WAY WA
98003-6357
US

V. Phone/Fax

Practice location:
  • Phone: 253-285-7101
  • Fax: 253-874-7096
Mailing address:
  • Phone: 253-285-7101
  • Fax: 253-874-7096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License NumberNC61656768
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: