Healthcare Provider Details

I. General information

NPI: 1407998859
Provider Name (Legal Business Name): MIGRANT HEALTH CENTER WESTERN REGION,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 BO MONTALVA
ENSENADA GUANICA PR
00647
US

IV. Provider business mailing address

P O BOX 190
MAYAGUEZ PR
00681
US

V. Phone/Fax

Practice location:
  • Phone: 787-821-3377
  • Fax: 787-821-5328
Mailing address:
  • Phone: 787-805-2900
  • Fax: 787-834-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number932
License Number StatePR

VIII. Authorized Official

Name: MR. REYNALDO SERRANO CARABALLO
Title or Position: DIRECTOR EJECUTIVO
Credential:
Phone: 787-805-2900