Provider Demographics
NPI:1053584326
Name:JORGE LONDONO MD PA
Entity type:Organization
Organization Name:JORGE LONDONO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONDONO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-663-4633
Mailing Address - Street 1:1607 PONCE DE LEON BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4036
Mailing Address - Country:US
Mailing Address - Phone:305-663-4633
Mailing Address - Fax:305-663-4638
Practice Address - Street 1:1607 PONCE DE LEON BLVD STE 208
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4036
Practice Address - Country:US
Practice Address - Phone:305-663-4633
Practice Address - Fax:305-663-4638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME891612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG29113Medicare UPIN