=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932359411
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIGRANT HEALTH CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2008
-----------------------------------------------------
Last Update Date | 09/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE RAMON E. BETANCES 392 SUR
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-805-7360
-----------------------------------------------------
Fax | 787-834-1924
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 190
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00681-0190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-805-7360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR EJECUTIVO
-----------------------------------------------------
Name | MR. REYNALDO SERRANO CARABALLO
-----------------------------------------------------
Credential | MR.
-----------------------------------------------------
Telephone | 787-805-7360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------