Provider Demographics
NPI:1750862785
Name:ADVANCED VASCULAR TESTING, LLC
Entity Type:Organization
Organization Name:ADVANCED VASCULAR TESTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:RVT, BHCS
Authorized Official - Phone:575-522-1974
Mailing Address - Street 1:755 S TELSHOR BLVD STE G2
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8669
Mailing Address - Country:US
Mailing Address - Phone:575-496-4482
Mailing Address - Fax:575-633-2698
Practice Address - Street 1:3850 E LOHMAN AVE STE C
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-522-1974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory