Healthcare Provider Details

I. General information

NPI: 1508682758
Provider Name (Legal Business Name): MOKOM AWA ALFRED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 NILES ST
BAKERSFIELD CA
93306-4922
US

IV. Provider business mailing address

7800 NILES ST
BAKERSFIELD CA
93306-4922
US

V. Phone/Fax

Practice location:
  • Phone: 661-328-4284
  • Fax: 661-616-9977
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPTL17801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: