Provider Demographics
NPI:1780830737
Name:COREPLUS SERVICIOS CLINICOS Y PATOLOGICOS LLC
Entity Type:Organization
Organization Name:COREPLUS SERVICIOS CLINICOS Y PATOLOGICOS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:DE SOCARRAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-992-4811
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:855-711-2673
Mailing Address - Fax:855-711-2673
Practice Address - Street 1:AVENIDA SANCHEZ VILELLA ESQ. PR-190
Practice Address - Street 2:SUITE 2-6
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:855-711-2673
Practice Address - Fax:855-711-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZP0102X
PR1049291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1049OtherSTATE LICENSE