Provider Demographics
NPI:1346657020
Name:LONDONO, LORENA (PA)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:LONDONO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 GLADES RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6464
Mailing Address - Country:US
Mailing Address - Phone:561-495-9511
Mailing Address - Fax:
Practice Address - Street 1:600 GLADES RD STE 200
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7239
Practice Address - Country:US
Practice Address - Phone:561-495-9511
Practice Address - Fax:561-990-7426
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9107950363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant