Healthcare Provider Details

I. General information

NPI: 1306057237
Provider Name (Legal Business Name): MIGRANT HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE RAMON EMETERIO BETANCES 392 SUR
MAYAGUEZ PR
00681-7128
US

IV. Provider business mailing address

MIGRANT HEALTH CENTER, I NC. P O BOX 7128
MAYAGUEZ PR
00681-7128
US

V. Phone/Fax

Practice location:
  • Phone: 787-805-2900
  • Fax: 787-834-1924
Mailing address:
  • Phone: 787-805-7360
  • Fax: 787-834-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number07F0890
License Number StatePR

VIII. Authorized Official

Name: MR. REYNALDO SERRANO CARABALLO
Title or Position: DIRECTOR EJECUTIVO
Credential:
Phone: 787-805-7360