MEDICARE: DIANA LONDONO

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	2084N0400X	Neurology Physician	62054	MN
2	2084N0400X	Neurology Physician	125063912	IL
3	2084N0400X	Neurology Physician	A173775	CA

General Provider Information

NPI Number	:	1801235700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA LONDONO

Provider Business Mailing Address
First Line	:	46100 WASHINGTON ST
Second Line	:
City	:	LA QUINTA
State	:	CA
Zip	:	92253-2042
Country	:	US
Telephone Number	:	760-340-0528
Fax Number	:	760-674-1590

Provider Business Practice Location Address
First Line	:	46100 WASHINGTON ST
Second Line	:
City	:	LA QUINTA
State	:	CA
Zip	:	92253-2042
Country	:	US
Telephone Number	:	760-340-0528
Fax Number	:	760-674-1590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2013
Last Update Date	:	09/15/2021

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Directions to “ DIANA LONDONO ” Practice Location

Language	Start Address	Practice Location

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