Provider Demographics
NPI:1588653802
Name:COREPLUS SERVICIOS CLINICOS Y PATOLOGICOS LLC
Entity Type:Organization
Organization Name:COREPLUS SERVICIOS CLINICOS Y PATOLOGICOS LLC
Other - Org Name:LABORATORIO CLINICO SAMA, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:DE SOCARRAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-711-2673
Mailing Address - Street 1:PO BOX 3376
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-3376
Mailing Address - Country:US
Mailing Address - Phone:877-787-7664
Mailing Address - Fax:787-841-7344
Practice Address - Street 1:1212 CALLE ACACIA
Practice Address - Street 2:SUITE 102
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2968
Practice Address - Country:US
Practice Address - Phone:787-259-7171
Practice Address - Fax:787-841-7344
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COREPLUS SERVICIOS CLINICOS Y PATOLOGICOS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-19
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR825291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
31341Medicare ID - Type Unspecified