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General NPI Number Information
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NPI Number | 1972327245
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Entity Type | Individual
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Provider Name | GREGORI RAFAEL TRONCOSO CANELA
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Gender | Male
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 505 AVE HOSTOS
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City | SAN JUAN
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State | PR
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Zip | 00918-3201
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Country | US
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Telephone | 787-488-0292
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Fax | 939-355-0129
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Provider Business Mailing Address
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Address Line | Y25 CALLE VIOLETA
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City | CAROLINA
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State | PR
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Zip | 00985-4251
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Country | US
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Telephone | 939-383-3113
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1589
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License Number State | PR
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