Provider Demographics
NPI:1740213594
Name:SWEETNAM, CHAD (PA-C)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:SWEETNAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19094 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-5447
Mailing Address - Country:US
Mailing Address - Phone:714-392-2321
Mailing Address - Fax:
Practice Address - Street 1:6276 RIVER CREST DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0754
Practice Address - Country:US
Practice Address - Phone:951-413-0964
Practice Address - Fax:951-653-5161
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18101363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0086790Medicaid
CAGR0086790Medicaid