Provider Demographics
NPI:1265191001
Name:NEXSUN DIAGNOSTIC LABORATORIES LLC
Entity type:Organization
Organization Name:NEXSUN DIAGNOSTIC LABORATORIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAFOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-903-5197
Mailing Address - Street 1:15375 BARRANCA PKWY STE A110
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2203
Mailing Address - Country:US
Mailing Address - Phone:847-903-5197
Mailing Address - Fax:
Practice Address - Street 1:15375 BARRANCA PKWY STE A110
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2203
Practice Address - Country:US
Practice Address - Phone:847-903-5197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory