Individual provider Active NPI

Christy Holmstrom, RRA

  • Vascular-Interventional Technology Radiologic Technologist
  • Mesa, AZ
National Provider Identifier
1013361625
Registry record updated Apr 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular-Interventional Technology Radiologic TechnologistTaxonomy code 2471V0106X
License
368780 Issued in AZ
Practice address
1457 W Southern Ave
Suite 26
Mesa, AZ 85202-4813
Phone
(480) 374-7354
Fax
(480) 371-1121
NPI assigned
Apr 20, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular-Interventional Technology Radiologic Technologist 2471V0106X 368780 AZ Primary

Addresses

Primary practice location

1457 W Southern Ave
Suite 26
Mesa, AZ 85202-4813

Mailing address

PO Box 64568
Phoenix, AZ 85082-4568
Phone (318) 424-4008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
368780AZMDVascular-Interventional Technology Radiologic Technologist

NPI Registry JSON

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

{
    "created_epoch": "1461110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461110400000",
    "number": "1013361625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64568",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850824568",
            "telephone_number": "318-424-4008",
            "fax_number": "855-230-1466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1457 W SOUTHERN AVE",
            "address_2": "SUITE 26",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024813",
            "telephone_number": "480-374-7354",
            "fax_number": "480-371-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMSTROM",
        "first_name": "CHRISTY",
        "credential": "RRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-20",
        "last_updated": "2016-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2471V0106X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Vascular-Interventional Technology",
            "state": "AZ",
            "license": "368780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2016; 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.