Healthcare Provider Details

I. General information

NPI: 1093262297
Provider Name (Legal Business Name): MIGRANT HEALTH CENTER WESTERN REGION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 05/19/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 128 KM 4.1 BARRIO ALMACIGO BAJO
YAUCO PR
00698-0000
US

IV. Provider business mailing address

PO BOX 190
MAYAGUEZ PR
00681-0190
US

V. Phone/Fax

Practice location:
  • Phone: 787-856-8416
  • Fax: 939-413-6799
Mailing address:
  • Phone: 787-831-5800
  • Fax: 787-832-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number18-F-3376
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