Provider Demographics
NPI:1548290851
Name:WEST REGIONAL CENTER
Entity type:Organization
Organization Name:WEST REGIONAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-251-9309
Mailing Address - Street 1:1779 W 37TH ST
Mailing Address - Street 2:BAY 1
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4671
Mailing Address - Country:US
Mailing Address - Phone:305-362-8384
Mailing Address - Fax:305-362-8929
Practice Address - Street 1:1779 W 37TH ST
Practice Address - Street 2:BAY 1
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4671
Practice Address - Country:US
Practice Address - Phone:305-362-8384
Practice Address - Fax:305-362-8929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3736174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4764Medicare ID - Type UnspecifiedFACILITY MEDICARE NUMBER