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General NPI Number Information
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NPI Number | 1952875049
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Entity Type | Organization
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Legal Business Name | VEGAFIT ELITE FITNESS AND TRAINING
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 01/11/2019
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Provider Practice Location Address
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Address Line | 91-2131 KAIOLI ST #3403
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City | EWA BEACH
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State | HI
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Zip | 96706
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Country | US
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Telephone | 808-260-0210
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Fax |
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Provider Business Mailing Address
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Address Line | 91-2131 KAIOLI ST #3403
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City | EWA BEACH
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State | HI
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Zip | 96706
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/FOUNDER
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Name | SHANE VEGA
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Credential |
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Telephone | 808-260-0210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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