Provider Demographics
NPI:1366534893
Name:TRONCOSO, VICTORIA (DO)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:TRONCOSO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9590 E IRONWOOD SQUARE DR
Mailing Address - Street 2:106
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4581
Mailing Address - Country:US
Mailing Address - Phone:480-391-7631
Mailing Address - Fax:480-314-5493
Practice Address - Street 1:9590 E IRONWOOD SQUARE DR
Practice Address - Street 2:106
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4581
Practice Address - Country:US
Practice Address - Phone:480-391-7631
Practice Address - Fax:480-314-5493
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDO2849204C00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ76288OtherPTAN
AZF72680Medicare UPIN