MEDICARE: JORGE LONDONO MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME89161	FL

General Provider Information

NPI Number	:	1053584326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORGE LONDONO MD PA

Provider Business Mailing Address
First Line	:	1607 PONCE DE LEON BLVD STE 208
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4036
Country	:	US
Telephone Number	:	305-663-4633
Fax Number	:	305-663-4638

Provider Business Practice Location Address
First Line	:	1607 PONCE DE LEON BLVD STE 208
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4036
Country	:	US
Telephone Number	:	305-663-4633
Fax Number	:	305-663-4638

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JORGE LONDONO
Credential	:	MD
Telephone Number	:	305-663-4633

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	10/05/2018

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