Active NPI
Jordyn Domino
- Phlebotomy Technician
- Houston, TX
National Provider Identifier
1568215739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Phlebotomy Technician
- License
- AE09854CBA4A6BBA
- Practice address
- 12436 FM 1960 Rd W Unit 1449
Houston, TX 77065-4809 - Phone
- (346) 714-4112
- NPI assigned
- Apr 8, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 | AE09854CBA4A6BBA | TX | Primary |
Addresses
Primary practice location
12436 FM 1960 Rd W Unit 1449
Houston, TX 77065-4809
Mailing address
12436 FM 1960 Rd W Unit 1449
Houston, TX 77065-4809
Phone (346) 714-4112
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 |
|---|---|---|---|
| AE09854CBA4A6BBA | TX | MD | Phlebotomy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712534400000",
"number": "1568215739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12436 FM 1960 RD W UNIT 1449",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770654809",
"telephone_number": "346-714-4112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12436 FM 1960 RD W UNIT 1449",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770654809",
"telephone_number": "346-714-4112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINO",
"first_name": "JORDYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-08",
"last_updated": "2024-04-08",
"certification_date": "2024-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "246RP1900X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Technician, Pathology, Phlebotomy",
"state": "TX",
"license": "AE09854CBA4A6BBA",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.