MEDICARE: ANNAIS TRONCOSO MSN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95016066	CA

General Provider Information

NPI Number	:	1568050169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNAIS TRONCOSO MSN, FNP-C

Provider Business Mailing Address
First Line	:	2402 IMPERIAL BUSINESS PARK DR STE 101
Second Line	:
City	:	IMPERIAL
State	:	CA
Zip	:	92251-4004
Country	:	US
Telephone Number	:	760-234-6068
Fax Number	:

Provider Business Practice Location Address
First Line	:	2402 IMPERIAL BUSINESS PARK DR STE 101
Second Line	:
City	:	IMPERIAL
State	:	CA
Zip	:	92251-4004
Country	:	US
Telephone Number	:	760-355-5267
Fax Number	:	760-355-5248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2021
Last Update Date	:	01/08/2021

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