Provider Demographics
NPI:1093337586
Name:VANGAURD GENETICS, LLC
Entity Type:Organization
Organization Name:VANGAURD GENETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:915-637-0087
Mailing Address - Street 1:3655 RESEARCH DRIVE
Mailing Address - Street 2:MSC3ARP, GENESIS-B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003
Mailing Address - Country:US
Mailing Address - Phone:575-489-6688
Mailing Address - Fax:
Practice Address - Street 1:3655 RESEARCH DRIVE
Practice Address - Street 2:MSC3ARP, GENESIS-B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003
Practice Address - Country:US
Practice Address - Phone:575-489-6688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32D2182725OtherCLIA