MEDICARE: DR. JORGE LONDONO M.D.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235125873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE LONDONO M.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	10/05/2018

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