Provider Demographics
NPI:1538586813
Name:BOUFALLA, HAFIDA (PA-C)
Entity type:Individual
Prefix:
First Name:HAFIDA
Middle Name:
Last Name:BOUFALLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6133 LEESBURG PIKE APT 402
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2162
Mailing Address - Country:US
Mailing Address - Phone:571-398-8795
Mailing Address - Fax:
Practice Address - Street 1:6133 LEESBURG PIKE APT 402
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2162
Practice Address - Country:US
Practice Address - Phone:571-398-8795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA031026363A00000X
VA0110004409363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant