Provider Demographics
NPI:1881820017
Name:MIGRANT HEALTH CENTER, WESTERN REGION INC.
Entity Type:Organization
Organization Name:MIGRANT HEALTH CENTER, WESTERN REGION INC.
Other - Org Name:LABORATORIO CLINICO MIGRANT HEALTH CENTER, INC.
Other - Org Type:Other 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:MR
Authorized Official - Phone:787-805-7360
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:787-805-7360
Mailing Address - Fax:787-805-7360
Practice Address - Street 1:CARR. 101 KM 7.1
Practice Address - Street 2:BO. PALMAREJO
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-808-1420
Practice Address - Fax:787-808-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1182291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1182OtherLICENCIA
PR2231OtherNUM. PROVEEDOR PMC