Provider Demographics
NPI:1427848431
Name:TRONCOSO SEVERINO, LUIS ANTONIO
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANTONIO
Last Name:TRONCOSO SEVERINO
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 1:521 W TILGHMAN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-2460
Mailing Address - Country:US
Mailing Address - Phone:484-522-4378
Mailing Address - Fax:
Practice Address - Street 1:CARR. #5 AVE. CENTRAL JUANITA FINAL
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:939-225-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty