Healthcare Provider Details

I. General information

NPI: 1104544378
Provider Name (Legal Business Name): MIGRANT HEALTH CENTER WESTERN REGION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 RES CANDELARIA # 186
MAYAGUEZ PR
00682-2714
US

IV. Provider business mailing address

PO BOX 190
MAYAGUEZ PR
00681-0190
US

V. Phone/Fax

Practice location:
  • Phone: 787-908-1342
  • Fax: 787-832-0740
Mailing address:
  • Phone: 787-831-5800
  • Fax: 787-832-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. TANIA RODRIGUEZ
Title or Position: CEO
Credential:
Phone: 787-831-5800