Organization
NEXGEN LAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM DEISSROTH (MANAGER)
(267) 592-0542
Entity
Organization
Contact information
Practice address
11350 SW VILLAGE PKWY, PORT ST LUCIE, FL 34987-2352
(267) 592-0542
Mailing address
7999 N FEDERAL HWY, 429, BOCA RATON, FL 33487-1682
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
FL
Other
Enumeration date
12/29/2015
Last updated
12/29/2015
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