Provider Demographics
NPI:1275363384
Name:VEGA VITALITY VENTURES INC.
Entity type:Organization
Organization Name:VEGA VITALITY VENTURES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:508-320-3289
Mailing Address - Street 1:551 BOYLSTON ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3680
Mailing Address - Country:US
Mailing Address - Phone:617-658-3421
Mailing Address - Fax:
Practice Address - Street 1:551 BOYLSTON ST STE 4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3680
Practice Address - Country:US
Practice Address - Phone:617-658-3421
Practice Address - Fax:617-604-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center