1417912130 NPI number — JOSE FELIPE GARCIA-TRONCOSO MD

Table of content: JOSE FELIPE GARCIA-TRONCOSO MD (NPI 1417912130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417912130 NPI number — JOSE FELIPE GARCIA-TRONCOSO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA-TRONCOSO
Provider First Name:
JOSE
Provider Middle Name:
FELIPE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417912130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1551
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VILLALBA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00766-1551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-847-1211
Provider Business Mailing Address Fax Number:
787-847-2672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2223 W DR. MARTIN LUTHER KING JR. BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33607-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-405-4385
Provider Business Practice Location Address Fax Number:
813-405-4506
Provider Enumeration Date:
04/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  8454 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ME63987 . This is a "FLORIDA MEDICAL BOARD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 108046700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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