MEDICARE: VANGUARD LABS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1043190226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANGUARD LABS LLC

Provider Business Mailing Address
First Line	:	28310 ROADSIDE DR STE 218
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4942
Country	:	US
Telephone Number	:	415-295-8242
Fax Number	:

Provider Business Practice Location Address
First Line	:	28310 ROADSIDE DR STE 218
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4942
Country	:	US
Telephone Number	:	415-295-8242
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. JOSHUA WOLF
Credential	:
Telephone Number	:	415-295-8242

Provider Enumeration Date	:	09/06/2025
Last Update Date	:	03/22/2026

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