Provider Demographics
NPI:1275262255
Name:BENOMRAN, ASMA
Entity Type:Individual
Prefix:
First Name:ASMA
Middle Name:
Last Name:BENOMRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1288 BROWNS MILL CT
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2000
Mailing Address - Country:US
Mailing Address - Phone:571-397-6651
Mailing Address - Fax:
Practice Address - Street 1:1288 BROWNS MILL CT
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-2000
Practice Address - Country:US
Practice Address - Phone:571-397-6651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
CA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist