Basic Information
| Provider Information | |||||||||
| NPI: | 1083650535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LICAS | ||||||||
| FirstName: | JOSEFA | ||||||||
| MiddleName: | BADAR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1241 HOLMGROVE DR | ||||||||
| Address2: | |||||||||
| City: | SAN MARCOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920782800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607987624 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2120 THIBODO CT | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920817965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582791223 | ||||||||
| FaxNumber: | 7605974880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 10/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A82991 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.