Dr. Moma LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

DR. MOMA LLC

Practice address

411 Lakewood Cir Ste B114
Colorado Springs, CO 80910-4629

Phone

(719) 597-4768

Fax

(719) 591-2309

NPI assigned

Jul 31, 2020

Last updated

Aug 3, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Sylvienash Moma, FNP

Title

Owner

Phone

(719) 646-9834

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596412800000",
    "number": "1457961864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 LAKEWOOD CIR STE B114",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809104629",
            "telephone_number": "719-597-4768",
            "fax_number": "719-591-2309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 LAKEWOOD CIR STE B114",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809104629",
            "telephone_number": "719-597-4768",
            "fax_number": "719-591-2309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. MOMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-31",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A",
        "authorized_official_last_name": "MOMA",
        "authorized_official_first_name": "SYLVIENASH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-646-9834",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.