Healthcare Provider Details

I. General information

NPI: 1235683020
Provider Name (Legal Business Name): DAVID DERANIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18090 BEACH BLVD SUITE 5
HUNTINGTON BEACH CA
92648-1327
US

IV. Provider business mailing address

18090 BEACH BLVD SUITE 5
HUNTINGTON BEACH CA
92648-1327
US

V. Phone/Fax

Practice location:
  • Phone: 714-841-2430
  • Fax: 714-841-2476
Mailing address:
  • Phone: 714-841-2430
  • Fax: 714-841-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCATC I 167485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: