Provider Demographics
NPI:1902456890
Name:ARNOLD, CHAD
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 DIAMOND MESA TRL SW APT 7804
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-3763
Mailing Address - Country:US
Mailing Address - Phone:505-235-0423
Mailing Address - Fax:
Practice Address - Street 1:2909 MONUMENT DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-6529
Practice Address - Country:US
Practice Address - Phone:505-235-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider