Provider Demographics
NPI:1932817046
Name:MOFA, JOHN ONYOLI
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ONYOLI
Last Name:MOFA
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 1:10121 PRINCE PL APT 201
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1108
Mailing Address - Country:US
Mailing Address - Phone:346-664-9221
Mailing Address - Fax:
Practice Address - Street 1:10121 PRINCE PL APT 201
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1108
Practice Address - Country:US
Practice Address - Phone:346-664-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant