Healthcare Provider Details

I. General information

NPI: 1104730308
Provider Name (Legal Business Name): FALENA MARTINE BENTABOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 MAIN ST
FREELAND WA
98249-9423
US

IV. Provider business mailing address

PO BOX 1237
FREELAND WA
98249-1237
US

V. Phone/Fax

Practice location:
  • Phone: 360-320-9094
  • Fax:
Mailing address:
  • Phone: 360-331-2225
  • Fax: 360-331-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACUP.AC.70169850
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: