Provider Demographics
NPI:1538105366
Name:SONORA QUEST LABORATORIES LLC
Entity Type:Organization
Organization Name:SONORA QUEST LABORATORIES LLC
Other - Org Name:
Other - Org Type:
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 1:424 S 56TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2177
Practice Address - Country:US
Practice Address - Phone:602-685-5000
Practice Address - Fax:623-505-1356
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEST DIAGNOSTICS CLINICAL LABORATORIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-21
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03D0528878291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ24689Medicare PIN