Active NPI
Kristine Domino
- Speech-Language Pathologist
- Albuquerque, NM
National Provider Identifier
1124125893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2739
- Practice address
- 2300 Menaul Blvd NE
Albuquerque, NM 87107-1851 - Phone
- (505) 272-0322
- Fax
- (505) 272-2014
- NPI assigned
- Sep 17, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2739 | NM | Primary |
Addresses
Primary practice location
2300 Menaul Blvd NE
Albuquerque, NM 87107-1851
Mailing address
800 Bradbury Dr SE Ste 116
Albuquerque, NM 87106-4310
Phone (505) 272-1476
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | UNMMG@direct.health.unm.edu |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141209001924 | NM | Practitioner - Qualified Speech Language Pathologist | 3779805304 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2739 | NM | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Unm Medical Group Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Developmental Disabilities Clinic/Center
- Albuquerque, NM
- NPI 1851614432
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739404800000",
"number": "1124125893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 BRADBURY DR SE STE 116",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871064310",
"telephone_number": "505-272-1476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 MENAUL BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871071851",
"telephone_number": "505-272-0322",
"fax_number": "505-272-2014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINO",
"first_name": "KRISTINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-17",
"last_updated": "2025-02-13",
"certification_date": "2025-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "2739",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "UNMMG@direct.health.unm.edu",
"affiliation": "N",
"address_1": "800 Bradbury Dr SE Ste 116",
"city": "Albuquerque",
"state": "NM",
"country_code": "US",
"postal_code": "871064310",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.