Provider Demographics
NPI:1740872860
Name:BENAVIDES WARD, ARACELI
Entity type:Individual
Prefix:
First Name:ARACELI
Middle Name:
Last Name:BENAVIDES WARD
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 1:3444 FAIRFAX DR APT 403
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-4474
Mailing Address - Country:US
Mailing Address - Phone:347-609-2558
Mailing Address - Fax:
Practice Address - Street 1:4701 SANGAMORE RD STE N270
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2528
Practice Address - Country:US
Practice Address - Phone:240-507-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5187133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist