MEDICARE: VEGA BAJA IMAGING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471V0105X	Vascular Sonography Radiologic Technologist

General Provider Information

NPI Number	:	1649916826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEGA BAJA IMAGING LLC

Provider Business Mailing Address
First Line	:	3998 CARR 2
Second Line	:
City	:	VEGA BAJA
State	:	PR
Zip	:	00693-4140
Country	:	US
Telephone Number	:	787-855-2687
Fax Number	:	787-858-8299

Provider Business Practice Location Address
First Line	:	3998 CARR 2
Second Line	:
City	:	VEGA BAJA
State	:	PR
Zip	:	00693-4140
Country	:	US
Telephone Number	:	787-855-2687
Fax Number	:	787-858-8299

Authorized Official
Title or Position	:	OWNER
Name	:	JOSE ROSSELO CAMACHO
Credential	:
Telephone Number	:	787-649-8221

Provider Enumeration Date	:	05/10/2022
Last Update Date	:	06/10/2022

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