Provider Demographics
NPI:1710727987
Name:MOKENA, ANDREW I
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:I
Last Name:MOKENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7275 SOUVERAIN LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-5657
Mailing Address - Country:US
Mailing Address - Phone:510-589-3747
Mailing Address - Fax:
Practice Address - Street 1:7275 SOUVERAIN LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-5657
Practice Address - Country:US
Practice Address - Phone:775-745-3238
Practice Address - Fax:866-598-4028
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation