Healthcare Provider Details

I. General information

NPI: 1063760767
Provider Name (Legal Business Name): MIGRANT HEALTH CENTER. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ZUZUAREGUI #7
MARICAO PR
00606-1700
US

IV. Provider business mailing address

CALLE RAMON E. BETANCES #392 SUR
MAYAGUEZ PR
00681
US

V. Phone/Fax

Practice location:
  • Phone: 787-838-3057
  • Fax: 787-832-0740
Mailing address:
  • Phone: 787-833-1868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number12-046
License Number StatePR

VIII. Authorized Official

Name: MR. REYNALDO SERRANO
Title or Position: CEO
Credential:
Phone: 787-833-1868