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
1	2085R0204X	Vascular & Interventional Radiology Physician
2	2085U0001X	Diagnostic Ultrasound Physician
3	208D00000X	General Practice Physician
4	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1265458558
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	:	PRESIDENTE
Name	:	JOSE ROSSELLO CAMACHO
Credential	:
Telephone Number	:	787-966-3882

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	09/09/2022

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Directions to “VEGA BAJA IMAGING LLC ” Practice Location

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