Organization
VANGAURD GENETICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEFAN ALFRED LONG BS (LABORATORY DIRECTOR)
(915) 637-0087
Entity
Organization
Contact information
Practice address
3655 RESEARCH DRIVE, MSC3ARP, GENESIS-B, LAS CRUCES, NM 88003
(575) 489-6688
Mailing address
3655 RESEARCH DRIVE, MSC3ARP, GENESIS-B, LAS CRUCES, NM 88003
(575) 489-6688
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32D2182725
CLIA
NM
Enumeration date
05/07/2020
Last updated
05/07/2020
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