Provider Demographics
NPI:1184299836
Name:LONDONO, GUSTAVO ADOLFO
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ADOLFO
Last Name:LONDONO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 N. S.R. 434
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714
Mailing Address - Country:US
Mailing Address - Phone:401-461-2211
Mailing Address - Fax:
Practice Address - Street 1:788 N. S.R. 434
Practice Address - Street 2:SUITE 108
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714
Practice Address - Country:US
Practice Address - Phone:401-461-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13-44-2092708246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical