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General NPI Number Information
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NPI Number | 1619361599
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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 | 03/27/2015
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 5310 W THUNDERBIRD RD STE 200
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City | GLENDALE
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State | AZ
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Zip | 85306-4706
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Country | US
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Telephone | 602-863-4057
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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 | CHIEF FINANCIAL OFFICER
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Name | MR. ALBERT NAMEY
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Credential |
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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 | 03D2093655
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License Number State | AZ
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