Healthcare Provider Details

I. General information

NPI: 1972278067
Provider Name (Legal Business Name): CHAD PHILIP PUTNAM HAD, HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39755 DATE ST STE 105
MURRIETA CA
92563-2007
US

IV. Provider business mailing address

2390 FARADAY AVE
CARLSBAD CA
92008-7216
US

V. Phone/Fax

Practice location:
  • Phone: 858-909-0770
  • Fax: 858-909-0880
Mailing address:
  • Phone: 589-090-7708
  • Fax: 858-909-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA7990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: