Healthcare Provider Details

I. General information

NPI: 1700973260
Provider Name (Legal Business Name): SONORA QUEST LABORATORIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 W EUGIE AVE STE 104
GLENDALE AZ
85304-1273
US

IV. Provider business mailing address

PO BOX 67150
PHOENIX AZ
85082-7150
US

V. Phone/Fax

Practice location:
  • Phone: 602-978-2441
  • 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 Number03D0965633
License Number StateAZ

VIII. Authorized Official

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