Provider Demographics
NPI:1164581583
Name:HAUPT III, JOHN J (MED CCC-A)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:HAUPT III
Suffix:
Gender:M
Credentials:MED CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91933-0095
Mailing Address - Country:US
Mailing Address - Phone:619-425-1111
Mailing Address - Fax:619-498-0846
Practice Address - Street 1:642 3RD AVE STE G
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5733
Practice Address - Country:US
Practice Address - Phone:619-425-1111
Practice Address - Fax:619-498-0846
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1261237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter