Provider Demographics
NPI:1619401296
Name:CORONA, SAMARIS BERENICE (MD)
Entity Type:Individual
Prefix:
First Name:SAMARIS
Middle Name:BERENICE
Last Name:CORONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9021 PARK ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9617
Mailing Address - Country:US
Mailing Address - Phone:239-432-5858
Mailing Address - Fax:239-482-6297
Practice Address - Street 1:9021 PARK ROYAL DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9617
Practice Address - Country:US
Practice Address - Phone:239-432-5858
Practice Address - Fax:239-482-6297
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL151418207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology