Provider Demographics
NPI:1386704179
Name:SUNTERRA ONCOLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:SUNTERRA ONCOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIVIS
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:KHAIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-875-5805
Mailing Address - Street 1:10503 W THUNDERBIRD BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3022
Mailing Address - Country:US
Mailing Address - Phone:623-875-5805
Mailing Address - Fax:623-875-5806
Practice Address - Street 1:10503 W THUNDERBIRD BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3022
Practice Address - Country:US
Practice Address - Phone:623-875-5805
Practice Address - Fax:623-875-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ78091Medicare ID - Type Unspecified