Provider Demographics
NPI:1093262297
Name:MIGRANT HEALTH CENTER WESTERN REGION, INC.
Entity Type:Organization
Organization Name:MIGRANT HEALTH CENTER WESTERN REGION, INC.
Other - Org Name:MIGRANT HEALTH CENTER WESTERN REGION, INC, FARMACIA YAUCO
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR EJECUTIVO
Authorized Official - Prefix:DR
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-831-5800
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0190
Mailing Address - Country:US
Mailing Address - Phone:787-831-5800
Mailing Address - Fax:787-832-0740
Practice Address - Street 1:CARRETERA 128 KM 4.1
Practice Address - Street 2:BARRIO ALMACIGO BAJO
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-0000
Practice Address - Country:US
Practice Address - Phone:787-856-8416
Practice Address - Fax:939-413-6799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18-F-33763336C0002X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRL18-F-3376OtherLICENCIA ESTABLECIMIENTO FARMACIA