Healthcare Provider Details

I. General information

NPI: 1114064102
Provider Name (Legal Business Name): MIGRANT HEALTH CENTER WESTERN REGION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 05/19/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO PIEDRAS BLANCAS CARR 119 KM 35.2
SAN SEBASTIAN PR
00696
US

IV. Provider business mailing address

PO BOX 190
MAYAGUEZ PR
00681-0190
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-1690
  • Fax: 787-896-1690
Mailing address:
  • Phone: 787-805-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number07F1447
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. TANIA RODRIGUEZ MORALES
Title or Position: DIRECTOR EJECUTIVO
Credential:
Phone: 787-831-5800