# VITALIY MEDICAL AESTHETICS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790404713
- **Authorized official:** ALICE WANGARI WAITHAKA FNP-BC,RN (FAMILY NURSE PRACTITIONER)
- **Authorized official phone:** (857) 701-5425

## Contact information

- **Practice address:** 10 DIXFIELD RD, WORCESTER, MA 01606-1084
- **Practice address phone:** (857) 701-5425
- **Practice address fax:** (508) 373-2429
- **Mailing address:** 10 DIXFIELD RD, WORCESTER, MA 01606-1084
- **Mailing address phone:** (857) 701-5425
- **Mailing address fax:** (508) 373-2429

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/23/2022
- **Last updated:** 08/23/2022