Provider Demographics
NPI:1043559297
Name:DIGIACOMO, DEBORAH (LM)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:DIGIACOMO
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 DIANA DR
Mailing Address - Street 2:404
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4823
Mailing Address - Country:US
Mailing Address - Phone:954-494-8489
Mailing Address - Fax:
Practice Address - Street 1:2300 DIANA DR
Practice Address - Street 2:404
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4823
Practice Address - Country:US
Practice Address - Phone:954-494-8489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW120176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340159600Medicaid