Provider Demographics
NPI:1639720063
Name:SOUTHERN ARIZONA LABORISTS, LLC
Entity type:Organization
Organization Name:SOUTHERN ARIZONA LABORISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:000-000-0000
Mailing Address - Street 1:3430 E SUNRISE DR STE 180
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-3236
Mailing Address - Country:US
Mailing Address - Phone:520-348-0938
Mailing Address - Fax:520-512-5401
Practice Address - Street 1:1171 W TARGET RANGE RD
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2415
Practice Address - Country:US
Practice Address - Phone:520-348-0938
Practice Address - Fax:520-512-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty