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General NPI Number Information
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NPI Number | 1093337586
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Entity Type | Organization
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Legal Business Name | VANGAURD GENETICS, LLC
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 05/07/2020
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Provider Practice Location Address
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Address Line | 3655 RESEARCH DRIVE MSC3ARP, GENESIS-B
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City | LAS CRUCES
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State | NM
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Zip | 88003
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Country | US
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Telephone | 575-489-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 3655 RESEARCH DRIVE MSC3ARP, GENESIS-B
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City | LAS CRUCES
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State | NM
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Zip | 88003
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Country | US
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Telephone | 575-489-6688
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Fax |
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | MR. STEFAN ALFRED LONG
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Credential | BS
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Telephone | 915-637-0087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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