Provider Demographics
NPI:1336994110
Name:MOKOKO, STAN EKUME (PA)
Entity Type:Individual
Prefix:
First Name:STAN
Middle Name:EKUME
Last Name:MOKOKO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36056 DARCY PL
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4563
Mailing Address - Country:US
Mailing Address - Phone:912-272-4640
Mailing Address - Fax:
Practice Address - Street 1:27315 JEFFERSON AVE STE J
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5609
Practice Address - Country:US
Practice Address - Phone:619-946-8194
Practice Address - Fax:877-353-8605
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR1983363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant