=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861864977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIGRANT HEALTH CENTER WESTERN REGION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2015
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE RAMON EMETERIO BETANCES 497 COND BLDG
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00680-1714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-805-2900
-----------------------------------------------------
Fax | 787-832-0740
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 190
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00681-0190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-833-5890
-----------------------------------------------------
Fax | 787-834-1924
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | TANIA RODRIGUEZ
-----------------------------------------------------
Credential | DRA
-----------------------------------------------------
Telephone | 787-831-5800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QM1000X
-----------------------------------------------------
Taxonomy Name | Migrant Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------