Provider Demographics
NPI:1225610579
Name:DIGIACOMO, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:DIGIACOMO
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 1:1160 BIRCH ST APT 25
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-6241
Mailing Address - Country:US
Mailing Address - Phone:262-719-8078
Mailing Address - Fax:
Practice Address - Street 1:1160 BIRCH ST APT 25
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-6241
Practice Address - Country:US
Practice Address - Phone:262-719-8078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist