Healthcare Provider Details

I. General information

NPI: 1710029400
Provider Name (Legal Business Name): MIGRANT HEALTH CENTER WESTERN REGION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. PLANAS CARRETERA 457 KM. 2.2
ISABELA PR
00662
US

IV. Provider business mailing address

PO BOX 190
MAYAGUEZ PR
00681-0190
US

V. Phone/Fax

Practice location:
  • Phone: 787-830-0243
  • Fax: 787-834-1924
Mailing address:
  • Phone: 787-805-7360
  • Fax: 787-834-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1000X
TaxonomyMigrant Health Clinic/Center
License Number06148
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

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