Provider Demographics
NPI:1003587601
Name:BENSOUIDI, LATIFA
Entity Type:Individual
Prefix:
First Name:LATIFA
Middle Name:
Last Name:BENSOUIDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATIFA
Other - Middle Name:
Other - Last Name:BENSOUIDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3041 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1527
Mailing Address - Country:US
Mailing Address - Phone:571-666-2026
Mailing Address - Fax:
Practice Address - Street 1:4400 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4422
Practice Address - Country:US
Practice Address - Phone:703-993-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program