Provider Demographics
NPI:1477640951
Name:SONORA QUEST LABORATORIES, LLC
Entity Type:Organization
Organization Name:SONORA QUEST LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMEY
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
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 1:1300 N 12TH ST STE 503
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2849
Practice Address - Country:US
Practice Address - Phone:602-239-2133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03D0994364291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ452152Medicaid
AZZ24689Medicare UPIN