Healthcare Provider Details

I. General information

NPI: 1801922448
Provider Name (Legal Business Name): DEIRDRE A. HABERMEHL, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 MAIN ST STE 204
HUNTINGTON BEACH CA
92648-1718
US

IV. Provider business mailing address

18800 MAIN ST STE 204
HUNTINGTON BEACH CA
92648-1718
US

V. Phone/Fax

Practice location:
  • Phone: 949-548-6376
  • Fax: 866-677-2855
Mailing address:
  • Phone: 949-548-6376
  • Fax: 866-677-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number61-1153
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG060299
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG60299
License Number StateCA

VIII. Authorized Official

Name: DEIRDRE ALLISON HABERMEHL
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 949-548-6376