MEDICARE: DIANA 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	208800000X	Urology Physician	ME116814	FL

General Provider Information

NPI Number	:	1710357769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANA LONDONO MD PA

Provider Business Mailing Address
First Line	:	219 NW 12TH AVE
Second Line	:	SUITE C-5
City	:	MIAMI
State	:	FL
Zip	:	33128-2205
Country	:	US
Telephone Number	:	305-548-4063
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 NW 12TH AVE
Second Line	:	SUITE C-5
City	:	MIAMI
State	:	FL
Zip	:	33128-2205
Country	:	US
Telephone Number	:	305-548-4063
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DIANA CRISTINA LONDONO
Credential	:	MD
Telephone Number	:	310-948-6680

Provider Enumeration Date	:	10/02/2015
Last Update Date	:	10/04/2015

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