Individual
LESILA MICHELLE FONOKALAFI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
TCM
Contact information
Practice address
237 26TH ST, OGDEN, UT 84401-3105
(801) 625-3700
(801) 625-3690
Mailing address
2046 ADAMS AVE REAR 3, OGDEN, UT 84401-0521
(801) 394-5733
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
876000308007
—
UT
Enumeration date
04/19/2007
Last updated
07/09/2007
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