Provider Demographics
NPI:1992953517
Name:BADEAUX, JOEL ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ALAN
Last Name:BADEAUX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5039 WESTSLOPE LN
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2766
Mailing Address - Country:US
Mailing Address - Phone:323-487-0874
Mailing Address - Fax:323-928-2485
Practice Address - Street 1:5039 WESTSLOPE LN
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-2766
Practice Address - Country:US
Practice Address - Phone:323-487-0874
Practice Address - Fax:323-928-2485
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1156332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ92069ZOtherCOUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#
CAFHC70042F, FHC70044OtherCOUNTY OF SANTA CRUZ MEDI-CAL PROVIDER #S
CAZZZ91892ZZOtherCOUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#
CAZZZ91891ZOtherCOUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#