Provider Demographics
NPI:1801235700
Name:LONDONO, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
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 1:46100 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2042
Mailing Address - Country:US
Mailing Address - Phone:760-340-0528
Mailing Address - Fax:760-674-1590
Practice Address - Street 1:46100 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2042
Practice Address - Country:US
Practice Address - Phone:760-340-0528
Practice Address - Fax:760-674-1590
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN620542084N0400X
IL1250639122084N0400X
CAA1737752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology