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General NPI Number Information
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NPI Number | 1134216567
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Entity Type | Organization
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Legal Business Name | SONORA QUEST LABORATORIES LLC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 77 W FOREST AVE STE 301
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-1483
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Country | US
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Telephone | 928-773-2260
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 67150
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City | PHOENIX
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State | AZ
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Zip | 85082-7150
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Country | US
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Telephone | 602-685-5000
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Fax | 602-685-5903
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. DAVID A DEXTER
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Credential | CEO
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Telephone | 602-685-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 03D1056168
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License Number State | AZ
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