Provider Demographics
NPI:1851041727
Name:DIGAMO, CRIS ANTAO (LAB TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:CRIS
Middle Name:ANTAO
Last Name:DIGAMO
Suffix:
Gender:M
Credentials:LAB TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14422 COOL OAK LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2235
Mailing Address - Country:US
Mailing Address - Phone:202-247-1871
Mailing Address - Fax:
Practice Address - Street 1:14422 COOL OAK LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2235
Practice Address - Country:US
Practice Address - Phone:202-247-1812
Practice Address - Fax:800-887-9017
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20-0217R246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy