Provider Demographics
NPI:1689306276
Name:BENNAAMARA, SOUAD
Entity Type:Individual
Prefix:
First Name:SOUAD
Middle Name:
Last Name:BENNAAMARA
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 1:830 S DOBSON RD UNIT 30
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-2954
Mailing Address - Country:US
Mailing Address - Phone:480-251-9609
Mailing Address - Fax:
Practice Address - Street 1:830 S DOBSON RD UNIT 30
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-2954
Practice Address - Country:US
Practice Address - Phone:480-251-9609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program