1619013067 NPI number — MIGRANT HEALTH CENTER

Table of content: CRAIG DYER HARRIS MD (NPI 1114092897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619013067 NPI number — MIGRANT HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIGRANT HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619013067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-0190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-831-5800
Provider Business Mailing Address Fax Number:
787-832-0740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO MONTALVA 23
Provider Second Line Business Practice Location Address:
ENSENADA
Provider Business Practice Location Address City Name:
GUANICA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-821-4511
Provider Business Practice Location Address Fax Number:
787-821-4511
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ MORALES
Authorized Official First Name:
TANIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR EJECUTIVO
Authorized Official Telephone Number:
787-831-5800

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: 07F1737 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4022175 . This is a "NABP NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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