Provider Demographics
NPI:1346382181
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
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR EJECUTIVO
Authorized Official - Prefix:MR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:SERRANO
Authorized Official - Last Name:CARABALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-805-2900
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:787-834-1924
Practice Address - Street 1:BO. PIEDRAS BLANCAS KM. 35.2
Practice Address - Street 2:CARR 119
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-1665
Practice Address - Fax:787-896-4570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR06148261QM1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherSEGURO SOCIAL PATRONAL
PR0082212Medicare ID - Type UnspecifiedNUM PROVEEDOR
PR=========OtherSEGURO SOCIAL PATRONAL