1922561190 NPI number — CHAD AUSTIN SERVICE

Table of content: CHAD AUSTIN SERVICE (NPI 1922561190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922561190 NPI number — CHAD AUSTIN SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SERVICE
Provider First Name:
CHAD
Provider Middle Name:
AUSTIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SERVICE
Provider Other First Name:
C
Provider Other Middle Name:
AUSTIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1922561190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2481 E RUSSELL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLADAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84117-4550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-824-8886
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9300 CAMPUS POINT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-657-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  13861809-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)