Provider Demographics
NPI:1083650535
Name:LICAS, JOSEFA BADAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEFA
Middle Name:BADAR
Last Name:LICAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 HOLMGROVE DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2800
Mailing Address - Country:US
Mailing Address - Phone:760-798-7624
Mailing Address - Fax:
Practice Address - Street 1:2120 THIBODO CT
Practice Address - Street 2:SUITE 230
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7965
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:760-597-4880
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA829912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry