Healthcare Provider Details

I. General information

NPI: 1336721034
Provider Name (Legal Business Name): SONORA QUEST LABORATORIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19646 N 27TH AVE STE 406
PHOENIX AZ
85027-4028
US

IV. Provider business mailing address

PO BOX 67150
PHOENIX AZ
85082-7150
US

V. Phone/Fax

Practice location:
  • Phone: 623-587-4868
  • Fax: 623-582-5300
Mailing address:
  • Phone: 602-685-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

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