Individual provider Active NPI

Jeffrey Valencia Domingo, RN

  • Home Health Registered Nurse
  • Honolulu, HI
National Provider Identifier
1205715000
Registry record updated Aug 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health Registered NurseTaxonomy code 163WH0200X
License
RN-88107 Issued in HI
Practice address
2670 Kalihi St
Honolulu, HI 96819-2808
Phone
(808) 382-1254
NPI assigned
Aug 27, 2025
Last updated
Aug 27, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Registered Nurse 163WH0200X RN-88107 HI Primary

Addresses

Primary practice location

2670 Kalihi St
Honolulu, HI 96819-2808

Mailing address

2670 Kalihi St
Honolulu, HI 96819-2808
Phone (808) 382-1254

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
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN-88107HIMDHome Health Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1756252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756252800000",
    "number": "1205715000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 KALIHI ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968192808",
            "telephone_number": "808-382-1254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2670 KALIHI ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968192808",
            "telephone_number": "808-382-1254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGO",
        "first_name": "JEFFREY",
        "middle_name": "VALENCIA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-08-27",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "HI",
            "license": "RN-88107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2025; 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.