Healthcare Provider Details

I. General information

NPI: 1336994110
Provider Name (Legal Business Name): STAN EKUME MOKOKO SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43300 BUSINESS PARK DR STE A105
TEMECULA CA
92590-3649
US

IV. Provider business mailing address

36056 DARCY PL
MURRIETA CA
92562-4563
US

V. Phone/Fax

Practice location:
  • Phone: 833-262-2185
  • Fax: 877-353-8605
Mailing address:
  • Phone: 912-272-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number102105
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number102105
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: