NPIMap

Organization Active NPI

Central Valley Pain Management & Wellness Inc.

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Modesto, CA
National Provider Identifier
1265565162
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X
License
PA13793 Issued in CA
Legal business name
CENTRAL VALLEY PAIN MANAGEMENT & WELLNESS INC.
Practice address
1300 Mable Ave
Suite 2
Modesto, CA 95355-1120
Phone
(209) 571-1992
Fax
(209) 571-1994
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Kristy Lindstrom, P.A.
Title
Spa Director
Phone
(209) 571-1992

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Neuromusculoskeletal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 204C00000X PA13793 CA Primary

Addresses

Primary practice location

1300 Mable Ave
Suite 2
Modesto, CA 95355-1120

Mailing address

1300 Mable Ave
Suite 2
Modesto, CA 95355-1120
Phone (209) 571-1992

National Provider Directory

National Provider Directory
Tax ID family
Central Valley Pain4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265565162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 MABLE AVE",
            "address_2": "SUITE 2",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551120",
            "telephone_number": "209-571-1992",
            "fax_number": "209-571-1994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 MABLE AVE",
            "address_2": "SUITE 2",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551120",
            "telephone_number": "209-571-1992",
            "fax_number": "209-571-1994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL VALLEY PAIN MANAGEMENT & WELLNESS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LINDSTROM",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_title_or_position": "SPA DIRECTOR",
        "authorized_official_telephone_number": "209-571-1992",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "P.A."
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "CA",
            "license": "PA13793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.