Healthcare Provider Details

I. General information

NPI: 1831231539
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: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 CALLE SAN RAFAEL LA SALUD
MAYAGUEZ PR
00680-4676
US

IV. Provider business mailing address

PO BOX 190
MAYAGUEZ PR
00681-0190
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-7255
  • Fax: 787-834-1924
Mailing address:
  • Phone: 787-805-2900
  • 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

VIII. Authorized Official

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