Healthcare Provider Details

I. General information

NPI: 1265458558
Provider Name (Legal Business Name): VEGA BAJA IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
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: 787-858-8299
Mailing address:
  • Phone: 787-855-2687
  • Fax: 787-858-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE ROSSELLO CAMACHO
Title or Position: PRESIDENTE
Credential:
Phone: 787-966-3882