Provider Demographics
NPI:1235125873
Name:LONDONO, JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:LONDONO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 PONCE DE LEON BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4036
Mailing Address - Country:US
Mailing Address - Phone:305-663-4633
Mailing Address - Fax:305-663-4638
Practice Address - Street 1:1607 PONCE DE LEON BLVD STE 208
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4036
Practice Address - Country:US
Practice Address - Phone:305-663-4633
Practice Address - Fax:305-663-4638
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME891612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269587100Medicaid
FL43281Medicare ID - Type Unspecified