1558755496 NPI number — NEXTGEN LABORATORIES, INC.

Table of content: (NPI 1558755496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558755496 NPI number — NEXTGEN LABORATORIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEXTGEN LABORATORIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558755496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4229 BIRCH ST
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92660-1902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-467-9770
Provider Business Mailing Address Fax Number:
949-272-3252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4229 BIRCH ST
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92660-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-467-9770
Provider Business Practice Location Address Fax Number:
949-272-3252
Provider Enumeration Date:
03/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DEL SIGNORE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
949-467-9770

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF00011097 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04373789 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558755496 . This is a "MEDICARE CROSSOVER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1558755496 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00569 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q052462 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026615500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1029235 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558755496 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558755496 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2431684 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0186222 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100449550 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29212545 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100067476 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200671730A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 534401800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 86272772 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003203849A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0589071 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1033640650001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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