Healthcare Provider Details

I. General information

NPI: 1932852894
Provider Name (Legal Business Name): VEGA BAJA RADIOLOGY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 CARR 2
VEGA BAJA PR
00693-4140
US

IV. Provider business mailing address

3998 CARR 2
VEGA BAJA PR
00693-4140
US

V. Phone/Fax

Practice location:
  • Phone: 787-855-2687
  • Fax:
Mailing address:
  • Phone: 787-855-2687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSE ROSEELLO CAMACHO
Title or Position: OWNER
Credential:
Phone: 787-649-8221