Provider Demographics
NPI:1114064102
Name:MIGRANT HEALTH CENTER WESTERN REGION INC
Entity Type:Organization
Organization Name:MIGRANT HEALTH CENTER WESTERN REGION INC
Other - Org Name:
Other - Org Type:
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:787-805-2900
Mailing Address - Fax:
Practice Address - Street 1:BO PIEDRAS BLANCAS CARR 119 KM 35.2
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00696
Practice Address - Country:US
Practice Address - Phone:787-896-1690
Practice Address - Fax:787-896-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07F14473336C0002X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4020690OtherNABP NUMBER