Provider Demographics
NPI:1104207778
Name:SONORA QUEST LABORATORIES LLC
Entity Type:Organization
Organization Name:SONORA QUEST LABORATORIES LLC
Other - Org Name:SONORA QUEST LABORATORIES - RUDASIL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:602-685-5000
Mailing Address - Street 1:PO BOX 67150
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-7150
Mailing Address - Country:US
Mailing Address - Phone:602-685-5000
Mailing Address - Fax:602-685-5903
Practice Address - Street 1:2070 W RUDASILL RD
Practice Address - Street 2:SUITE 130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7891
Practice Address - Country:US
Practice Address - Phone:520-544-3641
Practice Address - Fax:520-544-3739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03D2096833291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ452152Medicaid
AZZ24689Medicare UPIN