Provider Demographics
NPI:1700878394
Name:CENTRO RADIOLOGICO DE VEGA BAJA
Entity Type:Organization
Organization Name:CENTRO RADIOLOGICO DE VEGA BAJA
Other - Org Name:VEGA BAJA RADIOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSSELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCDO
Authorized Official - Phone:787-855-2687
Mailing Address - Street 1:3998 CARR 2
Mailing Address - Street 2:SECT. EL CRIOLLO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-4140
Mailing Address - Country:US
Mailing Address - Phone:787-855-2687
Mailing Address - Fax:787-858-8522
Practice Address - Street 1:3998 CARR 2
Practice Address - Street 2:SECT. EL CRIOLLO
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-4140
Practice Address - Country:US
Practice Address - Phone:787-855-2687
Practice Address - Fax:787-858-8522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty