Provider Demographics
NPI:1710703871
Name:DOMINGUEZ CHAVEZ, ANA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:DOMINGUEZ CHAVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 E PECOS RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-6077
Mailing Address - Country:US
Mailing Address - Phone:602-391-8872
Mailing Address - Fax:
Practice Address - Street 1:2141 E PECOS RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-6077
Practice Address - Country:US
Practice Address - Phone:480-769-7865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator