MEDICARE: MIGRANT HEALTH CENTER WESTERN REGION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	334132	OTHER	PR	LICENCE

General Provider Information

NPI Number	:	1528523578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIGRANT HEALTH CENTER WESTERN REGION, INC.

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00681-0190
Country	:	US
Telephone Number	:	787-831-5800
Fax Number	:	787-834-1924

Provider Business Practice Location Address
First Line	:	222 CALLE SAN RAFAEL
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-4676
Country	:	US
Telephone Number	:	787-834-7255
Fax Number	:	787-834-1924

Authorized Official
Title or Position	:	DIRECTORA EJECUTIVA
Name	:	MRS. DOLORES MORALES
Credential	:
Telephone Number	:	787-613-6918

Provider Enumeration Date	:	02/04/2019
Last Update Date	:	02/04/2019

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