Provider Demographics
NPI:1205457934
Name:NUGEN LABS, LLC
Entity type:Organization
Organization Name:NUGEN LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE TERREFORTE-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:939-545-0522
Mailing Address - Street 1:EDIFICIO CENTRAL
Mailing Address - Street 2:CALLE BALDORIOTY 165 NORTE, BUZON #2
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:939-545-0522
Mailing Address - Fax:939-545-0700
Practice Address - Street 1:EDIFICIO CENTRAL
Practice Address - Street 2:CALLE BALDORIOTY 165 NORTE, BUZON #2
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:939-545-0522
Practice Address - Fax:939-545-0700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIENESTAR HEALTH GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-05
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Multi-Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty