=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992953517
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOEL ALAN BADEAUX M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2008
-----------------------------------------------------
Last Update Date | 06/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5039 WESTSLOPE LN
-----------------------------------------------------
City | LA CANADA FLINTRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91011-2766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-487-0874
-----------------------------------------------------
Fax | 323-928-2485
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5039 WESTSLOPE LN
-----------------------------------------------------
City | LA CANADA FLINTRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91011-2766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-487-0874
-----------------------------------------------------
Fax | 323-928-2485
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | A115633
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------