Vega Baja Imaging LLC

Organization Active NPI Diagnostic Radiology Physician · Vega Baja, PR

NPI 1265458558 · NPPES record last updated Sep 9, 2022

Key facts

NPI
1265458558
Entity type
Organization (NPI type 2)
Primary specialty
Diagnostic Radiology Physician 2085R0202X
Legal business name
VEGA BAJA IMAGING LLC
Practice address
3998 Carr 2
Vega Baja, PR 00693-4140
Phone
(787) 855-2687
Fax
(787) 858-8299
NPI assigned
Jul 13, 2006
Organization subpart
No

Authorized official

Name
Jose Rossello Camacho
Title
Presidente
Phone
(787) 966-3882

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in PR

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20050804001034 PR Part B Supplier - Clinic/Group Practice 0244269744 Receives reassigned benefits from 2 practitioners
Practice locations: Vega Baja, PR

National Provider Directory

Locations

3998 Carr 2
Ste 2
Vega Baja, PR 00693
Phone (787) 855-2687

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician
Group: 193200000X MULTI-SPECIALTY GROUP
2085R0202X Yes
Vascular & Interventional Radiology Physician
Group: 193200000X MULTI-SPECIALTY GROUP
2085R0204X
Diagnostic Ultrasound Physician
Group: 193200000X MULTI-SPECIALTY GROUP
2085U0001X
General Practice Physician
Group: 193200000X MULTI-SPECIALTY GROUP
208D00000X

Addresses

Primary practice location

3998 Carr 2
Vega Baja, PR 00693-4140

Mailing address

3998 Carr 2
Vega Baja, PR 00693-4140
Phone (787) 855-2687

Other providers in Vega Baja, PR

All providers in Vega Baja, PR · Diagnostic Radiology Physician in Puerto Rico

Sources for this page

Verify at the official NPI Registry.