Healthcare Provider Details

I. General information

NPI: 1821487497
Provider Name (Legal Business Name): PAMELA ENJEMA MOKOKO FAMILY NURSE PRACTIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36056 DARCY PL
MURRIETA CA
92562-4563
US

IV. Provider business mailing address

27315 JEFFERSON AVE STE J
TEMECULA CA
92590-5609
US

V. Phone/Fax

Practice location:
  • Phone: 833-262-2185
  • Fax:
Mailing address:
  • Phone: 332-622-1858
  • Fax: 773-538-6058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN153499
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: