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General NPI Number Information
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NPI Number | 1902743248
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Entity Type | Individual
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Provider Name | SAMANTHA ELIZABETH BERNAL
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Gender | Female
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 723 SW 10TH STREET CONSEJO
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City | RENTON
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State | WA
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Zip | 98057
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Country | US
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Telephone | 206-786-7264
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Fax | 206-245-3906
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Provider Business Mailing Address
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Address Line | 25823 26TH PL S APT C102
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City | KENT
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State | WA
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Zip | 98032-5503
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Country | US
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Telephone | 206-245-3906
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Fax | 206-245-3906
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | CM70071575
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License Number State | WA
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