Healthcare Provider Details

I. General information

NPI: 1316474901
Provider Name (Legal Business Name): MIGRANT HEALTH CENTER WESTERN REGION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 05/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 BO MONTALVA
ENSENADA PR
00647
US

IV. Provider business mailing address

PO BOX 190
MAYAGUEZ PR
00681-0190
US

V. Phone/Fax

Practice location:
  • Phone: 787-821-3377
  • Fax: 787-834-1924
Mailing address:
  • Phone: 787-833-5890
  • Fax: 787-834-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number162914
License Number StatePR

VIII. Authorized Official

Name: MRS. DOLORES MORALES TORRES
Title or Position: DIRECTORA EJECUTIVA
Credential:
Phone: 787-833-5890