Provider Demographics
NPI:1932380029
Name:DANIELA BADEA-MIC MD, PA
Entity Type:Organization
Organization Name:DANIELA BADEA-MIC MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINITRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAGARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-850-8300
Mailing Address - Street 1:PO BOX 181194
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78480-1194
Mailing Address - Country:US
Mailing Address - Phone:361-850-8300
Mailing Address - Fax:361-850-8302
Practice Address - Street 1:3833 S STAPLES ST STE N112
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5201
Practice Address - Country:US
Practice Address - Phone:361-850-8300
Practice Address - Fax:361-850-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-18
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ68632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00798ZMedicare PIN