Healthcare Provider Details

I. General information

NPI: 1598198624
Provider Name (Legal Business Name): SONORA QUEST LABORATORIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 HWY 95 #H-81
BULLHEAD CITY AZ
86442-7860
US

IV. Provider business mailing address

PO BOX 67150
PHOENIX AZ
85082-7150
US

V. Phone/Fax

Practice location:
  • Phone: 928-704-7680
  • Fax:
Mailing address:
  • Phone: 602-685-5000
  • Fax: 602-685-5903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number03D2063484
License Number StateAZ

VIII. Authorized Official

Name: MR. AL NAMEY
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 602-685-5000