Active NPI
Steven Kenneth Holm, PA-C
- Physician Assistant
- Poway, CA
National Provider Identifier
1932257573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA13752
- Practice address
- 15611 Pomerado Rd
Suite 400
Poway, CA 92064-2437 - Phone
- (858) 613-8900
- NPI assigned
- Jan 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA13752 | CA | Primary |
Addresses
Primary practice location
15611 Pomerado Rd
Suite 400
Poway, CA 92064-2437
Mailing address
PO Box 28199
San Diego, CA 92198-0199
Phone (858) 613-8900
Other practice location 1
1809 National Ave
San Diego, CA 92113-2113
Phone (619) 515-2300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA13752 | Other | CA | LIC# |
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA13752 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617753600000",
"number": "1932257573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 28199",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921980199",
"telephone_number": "858-613-8900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15611 POMERADO RD",
"address_2": "SUITE 400",
"city": "POWAY",
"state": "CA",
"postal_code": "920642437",
"telephone_number": "858-613-8900"
}
],
"practiceLocations": [
{
"address_1": "1809 National Ave",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "921132113",
"country_code": "US",
"telephone_number": "619-515-2300",
"fax_number": "619-515-2510",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HOLM",
"first_name": "STEVEN",
"middle_name": "KENNETH",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2021-04-07",
"certification_date": "2021-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA13752",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LIC#",
"identifier": "PA13752",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Poway, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.