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General NPI Number Information
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NPI Number | 1801854914
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Entity Type | Individual
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Provider Name | RANDI HERBOLARIO BACULI MD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 1151 N BUCKNER BLVD BLDG 1
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City | DALLAS
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State | TX
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Zip | 75218-3426
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Country | US
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Telephone | 972-423-0977
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Fax | 972-578-1867
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Provider Business Mailing Address
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Address Line | 2504 FIGTREE LN
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City | PLANO
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State | TX
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Zip | 75074-4858
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Country | US
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Telephone | 972-423-0977
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Fax | 972-578-1867
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01051720A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
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License Number | 102027
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | CI0006180
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License Number State | DE
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | L2117
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License Number State | TX
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