Provider Demographics
NPI:1881319838
Name:SOUISSI, ASMA BENT TAOUF (MD)
Entity type:Individual
Prefix:MRS
First Name:ASMA
Middle Name:BENT TAOUF
Last Name:SOUISSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021 ALDUS DRIVE
Mailing Address - Street 2:UNIT 103
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117
Mailing Address - Country:US
Mailing Address - Phone:805-696-3506
Mailing Address - Fax:
Practice Address - Street 1:80 E HILLCREST DR
Practice Address - Street 2:STE 102
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-497-3575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC176160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine