Active NPI
Carrie Jackson, CA-CPT1
- Phlebotomy Technician
- Diamond Bar, CA
National Provider Identifier
1417727595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Phlebotomy Technician
- License
- CPT00064512
- Practice address
- 1370 Valley Vista Dr Ste 200
Diamond Bar, CA 91765-3921 - Phone
- (840) 236-0671
- NPI assigned
- Jan 8, 2024
- Last updated
- May 10, 2024
- 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 |
|---|---|---|---|---|
| Phlebotomy Technician | 246RP1900X | CPT00064512 | CA | Primary |
Addresses
Primary practice location
1370 Valley Vista Dr Ste 200
Diamond Bar, CA 91765-3921
Mailing address
1370 Valley Vista Dr Ste 200
Diamond Bar, CA 91765-3921
Phone (840) 236-0671
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
| License | State | Type | Specialty |
|---|---|---|---|
| CPT00064512 | CA | MD | Phlebotomy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715299200000",
"number": "1417727595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1370 VALLEY VISTA DR STE 200",
"city": "DIAMOND BAR",
"state": "CA",
"postal_code": "917653921",
"telephone_number": "840-236-0671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1370 VALLEY VISTA DR STE 200",
"city": "DIAMOND BAR",
"state": "CA",
"postal_code": "917653921",
"telephone_number": "840-236-0671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CARRIE",
"credential": "CA-CPT1",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-08",
"last_updated": "2024-05-10",
"certification_date": "2024-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "246RP1900X",
"taxonomy_group": "",
"desc": "Technician, Pathology, Phlebotomy",
"state": "CA",
"license": "CPT00064512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Diamond Bar, CA
- Ivigrx LLC (Specialty Care RX)
- J Chung Morita Chiropractic Inc. (Better Health Chiropractic)
- J Kim DDS Inc
- Leila Khoury Jabaji, M.D
- Jack B. Oh, DDS a Professional Corporation
- Kimberly Ann Jackson
- Jarama, Inc. (Visiting Angels, Living Assistance Services)
- Jay I. Bhatt DDS
- Jayant I. Bhatt, DDS
- Jeon Cho Dental Partnership
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.