Healthcare Provider Details

I. General information

NPI: 1497780563
Provider Name (Legal Business Name): MARK D. HABERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E 2ND AVE
ESCONDIDO CA
92025-4249
US

IV. Provider business mailing address

225 EAST SECOND AVENUE
ESCONDIDO CA
92025-4249
US

V. Phone/Fax

Practice location:
  • Phone: 760-291-6700
  • Fax: 760-737-7324
Mailing address:
  • Phone: 760-291-6700
  • Fax: 760-737-7324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG83540
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG83540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: