Provider Demographics
NPI:1619191533
Name:CLEAR CHOICE CLINIC
Entity Type:Organization
Organization Name:CLEAR CHOICE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAUPT
Authorized Official - Suffix:III
Authorized Official - Credentials:MA
Authorized Official - Phone:619-425-1111
Mailing Address - Street 1:642 3RD AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5727
Mailing Address - Country:US
Mailing Address - Phone:619-425-1111
Mailing Address - Fax:619-498-0846
Practice Address - Street 1:642 3RD AVE
Practice Address - Street 2:SUITE G
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5727
Practice Address - Country:US
Practice Address - Phone:619-425-1111
Practice Address - Fax:619-498-0846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1261231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU1261OtherSTATE LICENSE