Provider Demographics
NPI:1417912130
Name:GARCIA-TRONCOSO, JOSE FELIPE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:FELIPE
Last Name:GARCIA-TRONCOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1551
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-1551
Mailing Address - Country:US
Mailing Address - Phone:787-847-1211
Mailing Address - Fax:787-847-2672
Practice Address - Street 1:2223 W DR. MARTIN LUTHER KING JR. BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-0000
Practice Address - Country:US
Practice Address - Phone:813-405-4385
Practice Address - Fax:813-405-4506
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8454208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME63987OtherFLORIDA MEDICAL BOARD
PRE73862Medicare UPIN