Healthcare Provider Details

I. General information

NPI: 1780830737
Provider Name (Legal Business Name): COREPLUS SERVICIOS CLINICOS Y PATOLOGICOS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 12/10/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA SANCHEZ VILELLA ESQ. PR-190 SUITE 2-6
CAROLINA PR
00983
US

IV. Provider business mailing address

PO BOX 3376
CAROLINA PR
00984-3376
US

V. Phone/Fax

Practice location:
  • Phone: 855-711-2673
  • Fax: 855-711-2673
Mailing address:
  • Phone: 855-711-2673
  • Fax: 855-711-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1049
License Number StatePR

VIII. Authorized Official

Name: MR. MARIANO DE SOCARRAZ
Title or Position: PRESIDENT
Credential:
Phone: 305-992-4811