Healthcare Provider Details

I. General information

NPI: 1194148726
Provider Name (Legal Business Name): SONORA QUEST LABORATORIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 08/11/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 S LACANADA DR STE 208
GREEN VALLEY AZ
85614-1943
US

IV. Provider business mailing address

PO BOX 67150
PHOENIX AZ
85082-7150
US

V. Phone/Fax

Practice location:
  • Phone: 520-399-1150
  • 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 Number03D2070708
License Number StateAZ

VIII. Authorized Official

Name: NICHOLE KERR
Title or Position: SENIOR DIRECTOR, REVENUE SERVICES
Credential:
Phone: 602-685-5427