Provider Demographics
NPI:1558591404
Name:MOKOFISI, ROSHETTA
Entity Type:Individual
Prefix:
First Name:ROSHETTA
Middle Name:
Last Name:MOKOFISI
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 1:979 N 1125 W
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4851
Mailing Address - Country:US
Mailing Address - Phone:801-230-2905
Mailing Address - Fax:
Practice Address - Street 1:979 N 1125 W
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4851
Practice Address - Country:US
Practice Address - Phone:801-230-2905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator