Healthcare Provider Details

I. General information

NPI: 1235664277
Provider Name (Legal Business Name): MIGRANT HEALTH CENTER WESTERN REGION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CALLE LUIS MONTALVO BO MARAVILLA NORTE
LAS MARIAS PR
00670
US

IV. Provider business mailing address

PO BOX 190
MAYAGUEZ PR
00681-0190
US

V. Phone/Fax

Practice location:
  • Phone: 787-827-3798
  • 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 Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TANIA RODRIGUEZ
Title or Position: DIRECTORA EJECUTIVA
Credential: DRA.
Phone: 787-831-5800