Healthcare Provider Details

I. General information

NPI: 1700207750
Provider Name (Legal Business Name): SONORA QUEST LABORATORIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13640 N PLAZA DEL RIO BLVD
PEORIA AZ
85381-4846
US

IV. Provider business mailing address

PO BOX 67150
PHOENIX AZ
85082-7150
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-3998
  • Fax: 623-876-3928
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 Number03D0531185
License Number StateAZ

VIII. Authorized Official

Name: MR. DAVID A DEXTER
Title or Position: PRESIDENT/CEO
Credential: CEO
Phone: 602-685-5000