Healthcare Provider Details

I. General information

NPI: 1023065570
Provider Name (Legal Business Name): DEIRDRE ALLISON HABERMEHL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 MAIN ST STE 204
HUNTINGTON BEACH CA
92648-1707
US

IV. Provider business mailing address

18800 MAIN ST STE 204
HUNTINGTON BEACH CA
92648-1707
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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG60299
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberG60299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: