Basic Information
| Provider Information | |||||||||
| NPI: | 1346657020 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LONDONO | ||||||||
| FirstName: | LORENA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 GLADES RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334316464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614959511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 GLADES RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334317239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614959511 | ||||||||
| FaxNumber: | 5619907426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2014 | ||||||||
| LastUpdateDate: | 11/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA 9107950 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.