Healthcare Provider Details

I. General information

NPI: 1336764307
Provider Name (Legal Business Name): MIGRANT HEALTH CENTER WESTERN REGION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA ESTATAL #100 KM. 6.1 BARRIO MIRADERO
CABO ROJO PR
00623-0000
US

IV. Provider business mailing address

PO BOX 190
MAYAGUEZ PR
00681-0190
US

V. Phone/Fax

Practice location:
  • Phone: 787-940-0911
  • Fax:
Mailing address:
  • Phone: 787-831-5800
  • Fax: 787-832-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. DOLORES MORALES TORRES
Title or Position: DIRECTORA EJECUTIVA
Credential:
Phone: 787-613-6918