=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215877063
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXLAB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2026
-----------------------------------------------------
Last Update Date | 03/31/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 W 1ST ST STE 214
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92701-8217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-882-6132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 W 1ST ST STE 214
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92701-8217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-882-6132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICER
-----------------------------------------------------
Name | SAED SADEGHI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-882-6132
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------