Provider Demographics
NPI:1972278067
Name:PUTNAM, CHAD PHILIP (HAD, HIS)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:PHILIP
Last Name:PUTNAM
Suffix:
Gender:M
Credentials:HAD, HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 FARADAY AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7216
Mailing Address - Country:US
Mailing Address - Phone:589-090-7708
Mailing Address - Fax:858-909-0770
Practice Address - Street 1:39755 DATE ST STE 105
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2007
Practice Address - Country:US
Practice Address - Phone:858-909-0770
Practice Address - Fax:858-909-0880
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7990237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist