Provider Demographics
NPI:1619771524
Name:DIGIACOMO, CALEB
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:DIGIACOMO
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-2612
Mailing Address - Country:US
Mailing Address - Phone:402-973-4123
Mailing Address - Fax:
Practice Address - Street 1:4611 S 96TH ST STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1220
Practice Address - Country:US
Practice Address - Phone:402-506-9368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide