Healthcare Provider Details

I. General information

NPI: 1689432692
Provider Name (Legal Business Name): GABRIELA LONDONO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 DRY CREEK DR
LONGMONT CO
80503-6405
US

IV. Provider business mailing address

1610 DRY CREEK DR
LONGMONT CO
80503-6405
US

V. Phone/Fax

Practice location:
  • Phone: 303-772-1600
  • Fax: 303-772-9317
Mailing address:
  • Phone: 303-772-1600
  • Fax: 303-772-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009334
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: