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General NPI Number Information
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NPI Number | 1750003075
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Entity Type | Individual
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Provider Name | MALGORZATA DOMAGALA AMFT
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Gender | Female
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 4405 W RIVERSIDE DR
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City | BURBANK
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State | CA
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Zip | 91505-4072
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Country | US
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Telephone | 877-505-4025
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6264
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92607-6264
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Country | US
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Telephone | 714-234-4832
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 109085
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License Number State | CA
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