Provider Demographics
NPI:1871693085
Name:BADRTALEI, SUSAN K (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:K
Last Name:BADRTALEI
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:22581 PUNTAL LANA
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1337
Mailing Address - Country:US
Mailing Address - Phone:949-533-4049
Mailing Address - Fax:949-380-1471
Practice Address - Street 1:12373 LEWIS ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4676
Practice Address - Country:US
Practice Address - Phone:949-533-4049
Practice Address - Fax:714-867-6033
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2013-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY20484103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP20484Medicare PIN