| Angel L Dominguez, LICSW | |
|
301 2nd St Ne, New Prague, MN 56071-1709 | |
| (952) 758-4431 | |
| Not Available |
| Full Name | Angel L Dominguez |
|---|---|
| Gender | Female |
| Speciality | Social Worker - Clinical |
| Location | 301 2nd St Ne, New Prague, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891579827 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 26733 (Minnesota) | Primary |
| 1041C0700X | Social Worker - Clinical | 082177 (Iowa) | Secondary |
| Entity Name | Mayo Clinic Health System-southwest Minnesota Region |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1578545422 PECOS PAC ID: 4688585771 Enrollment ID: O20031110000134 |
| Entity Name | Mayo Clinic Health System-fairmont |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1366410862 PECOS PAC ID: 4981694981 Enrollment ID: O20040719000142 |
| Entity Name | Mayo Clinic Health System-southwest Minnesota Region |
|---|---|
| Entity Type | Part A Provider - Critical Access Hospital |
| Entity Identifiers | NPI Number: 1124035282 PECOS PAC ID: 4688585771 Enrollment ID: O20171011003939 |
| Mailing Address | Practice Location Address |
|---|---|
| Angel L Dominguez, LICSW 200 1st St Sw, Rochester, MN 55905-0001 Ph: (507) 284-2511 | Angel L Dominguez, LICSW 301 2nd St Ne, New Prague, MN 56071-1709 Ph: (952) 758-4431 |
Nicole Kristine Hachfeld, LICSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 301 2nd St Ne, New Prague, MN 56071 Phone: 952-758-8918 Fax: 952-758-8146 |