Healthcare Provider Details

I. General information

NPI: 1215475744
Provider Name (Legal Business Name): AMOMA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 S GRAND BLVD STE 2
SPOKANE WA
99202-1174
US

IV. Provider business mailing address

3690 W GANDY BLVD
TAMPA FL
33611-2608
US

V. Phone/Fax

Practice location:
  • Phone: 813-955-2827
  • Fax: 866-611-7552
Mailing address:
  • Phone: 509-228-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberAP60643395
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberAP60643395
License Number StateWA

VIII. Authorized Official

Name: DR. ARCHIEL BUAGAS-KINTANAR
Title or Position: PROVIDER/OWNER
Credential: ARNP, PMHNP-BC
Phone: 509-228-8323