1922188747 NPI number — SONORA QUEST LABORATORIES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922188747 NPI number — SONORA QUEST LABORATORIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SONORA QUEST LABORATORIES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922188747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85082-7150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-685-5000
Provider Business Mailing Address Fax Number:
602-685-5903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 N WILMOT RD
Provider Second Line Business Practice Location Address:
STE 141
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85711-2701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-296-0426
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEXTER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
602-685-5000

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  03D1050496 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 452152 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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