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General NPI Number Information
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NPI Number | 1336994110
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Entity Type | Individual
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Provider Name | STAN MOKOKO MD
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Gender | Male
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 1695 S SAN JACINTO AVE STE A
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City | SAN JACINTO
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State | CA
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Zip | 92583-5103
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Country | US
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Telephone | 951-330-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 36056 DARCY PL
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City | MURRIETA
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State | CA
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Zip | 92562-4563
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Country | US
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Telephone | 912-272-4640
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10004
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1983
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 102105
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License Number State | GA
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