Provider Demographics
NPI:1922375674
Name:XANOGENE LLC
Entity Type:Organization
Organization Name:XANOGENE LLC
Other - Org Name:XANOGENE, ANTI AGING, GENOMIC & HOLISTIC CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:PROF
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:B
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-761-5880
Mailing Address - Street 1:300 FELISA RINCON
Mailing Address - Street 2:LAS VISTAS SHOPPING VILLAGE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-761-5880
Mailing Address - Fax:
Practice Address - Street 1:300 AVE FELISA RINCON
Practice Address - Street 2:LAS VISTAS SHOPPING VILLAGE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6088
Practice Address - Country:US
Practice Address - Phone:787-761-5880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty