Provider Demographics
NPI:1679747042
Name:LONDONO, MATILDE M
Entity Type:Individual
Prefix:MISS
First Name:MATILDE
Middle Name:M
Last Name:LONDONO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5673 24TH TER N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4222
Mailing Address - Country:US
Mailing Address - Phone:727-381-3106
Mailing Address - Fax:727-381-3106
Practice Address - Street 1:5673 24TH TER N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-4222
Practice Address - Country:US
Practice Address - Phone:727-381-3106
Practice Address - Fax:727-381-3106
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide