Healthcare Provider Details

I. General information

NPI: 1780164194
Provider Name (Legal Business Name): MIGRANT HEALTH CENTER WESTERN REGION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 AVENIDA WILLIAM DUNSCOMBE BO SABALOS
MAYAGUEZ PR
00682-2432
US

IV. Provider business mailing address

PO BOX 190
MAYAGUEZ PR
00681-0190
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-1880
  • Fax: 787-834-1924
Mailing address:
  • Phone: 787-833-1880
  • Fax: 787-834-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DOLORES MORALES
Title or Position: DIRECTORA EJECUTIVA
Credential: SRA.
Phone: 787-613-6918