Healthcare Provider Details

I. General information

NPI: 1346128311
Provider Name (Legal Business Name): CHAD OTTEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 COYLE AVE
CARMICHAEL CA
95608-0306
US

IV. Provider business mailing address

2203 LOS PATOS DR
PALM SPRINGS CA
92264-6011
US

V. Phone/Fax

Practice location:
  • Phone: 916-537-5365
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95363987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: