Provider Demographics
NPI:1619624616
Name:SUNTERRA PRODUCE TRADERS, INC.
Entity Type:Organization
Organization Name:SUNTERRA PRODUCE TRADERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAZEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-673-0073
Mailing Address - Street 1:PO BOX 5435
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92662-5435
Mailing Address - Country:US
Mailing Address - Phone:949-673-0073
Mailing Address - Fax:949-673-0423
Practice Address - Street 1:892 W 18TH ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4411
Practice Address - Country:US
Practice Address - Phone:949-673-0073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals