MEDICARE: MALGORZATA DOMAGALA LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	150999	CA

General Provider Information

NPI Number	:	1750003075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALGORZATA DOMAGALA LMFT

Provider Business Mailing Address
First Line	:	PO BOX 6264
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92607-6264
Country	:	US
Telephone Number	:	949-334-7277
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 N TUSTIN AVE STE 265
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3775
Country	:	US
Telephone Number	:	866-766-4935
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	04/15/2026

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