MEDICARE: ANA M DOMINGUEZ RD

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	133VN1401X	Pediatric Critical Care Nutrition Registered Dietitian	858579	AZ

General Provider Information

NPI Number	:	1326907759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA M DOMINGUEZ RD

Provider Business Mailing Address
First Line	:	PO BOX 2536
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85299-2536
Country	:	US
Telephone Number	:	480-412-7863
Fax Number	:

Provider Business Practice Location Address
First Line	:	1432 S DOBSON RD STE 402
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-4777
Country	:	US
Telephone Number	:	480-412-5550
Fax Number	:

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

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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