Provider Demographics
NPI:1093974651
Name:BESONG, ALICE E (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:E
Last Name:BESONG
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:PO BOX 5201
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92052-5201
Mailing Address - Country:US
Mailing Address - Phone:484-274-1488
Mailing Address - Fax:
Practice Address - Street 1:1000 VALE TERRACE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5218
Practice Address - Country:US
Practice Address - Phone:760-631-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-08
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123086207Q00000X
CAC162037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME123086OtherFLORIDA LICENSE
GAGA73504OtherGEORGIA MEDICAL LICENSE
FL014627100Medicaid
NYNY263473OtherNEW YORK MEDICAL LICENSE
FL014627100Medicaid
FLME123086OtherFLORIDA LICENSE
FLFB2920139OtherDEA