Provider Demographics
NPI:1679351142
Name:BESONGTAKU, ALINE E
Entity Type:Individual
Prefix:
First Name:ALINE
Middle Name:E
Last Name:BESONGTAKU
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 1:9979 GOOD LUCK RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3282
Mailing Address - Country:US
Mailing Address - Phone:443-610-9088
Mailing Address - Fax:
Practice Address - Street 1:9979 GOOD LUCK RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3282
Practice Address - Country:US
Practice Address - Phone:443-610-9088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator