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Individual

MR. IBRAHIM BENSOUDA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
REGISTERED DIETITIAN

Contact information

Practice address
1775 TYSONS BLVD FL 5, TYSONS, VA 22102-4285
(703) 459-8656
Mailing address
9088 TANYARD LN, LORTON, VA 22079-5210

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86358477

Other

Enumeration date
11/06/2024
Last updated
11/26/2024
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