NEXTGEN LABORATORIES, INC.

Provider Demographics

• NPI: 1558755496
• Name: NEXTGEN LABORATORIES, INC.
• Entity Type: Organization
• Organization Name: NEXTGEN LABORATORIES, INC.
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: JOSEPH
• Authorized Official - Last Name: DEL SIGNORE
• Authorized Official - Phone: 949-467-9770
• Mailing Address - Street 1: 4229 BIRCH ST
• Mailing Address - Street 2: SUITE 130
• Mailing Address - City: NEWPORT BEACH
• Mailing Address - State: CA
• Mailing Address - Zip Code: 92660-1902
• Mailing Address - Country: US
• Mailing Address - Phone: 949-467-9770
• Mailing Address - Fax: 949-272-3252
• Practice Address - Street 1: 4229 BIRCH ST
• Practice Address - Street 2: SUITE 130
• Practice Address - City: NEWPORT BEACH
• Practice Address - State: CA
• Practice Address - Zip Code: 92660-1902
• Practice Address - Country: US
• Practice Address - Phone: 949-467-9770
• Practice Address - Fax: 949-272-3252
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: GORDIAN MEDICAL, INC.
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2015-03-27
• Last Update Date: 2023-09-28

Provider Licenses

State	License ID	Taxonomies
CA	CLF00011097	291U00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	291U00000X	Laboratories	Clinical Medical Laboratory

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MS	04373789	Medicaid
CA	1558755496	Other	MEDICARE CROSSOVER
UT	1558755496	Medicaid
SC	L00569	Medicaid
TN	Q052462	Medicaid
NE	10026615500	Medicaid
VT	1029235	Medicaid
MO	1558755496	Medicaid
WY	1558755496	Medicaid
LA	2431684	Medicaid
OH	0186222	Medicaid
KY	7100449550	Medicaid
CO	29212545	Medicaid
WI	100067476	Medicaid
OK	200671730A	Medicaid
MD	534401800	Medicaid
NM	86272772	Medicaid
GA	003203849A	Medicaid
NJ	0589071	Medicaid
PA	1033640650001	Medicaid
IA	1558755496	Medicaid
MT	1558755496	Medicaid
IL	1558755496	Medicaid
ID	1558755496	Medicaid
WA	2081765	Medicaid
AZ	230378	Medicaid
IN	300001174	Medicaid
	CB262885	Other	MEDICARE PTAN
MN	1558755496	Medicaid