MEDICARE: DR. DEIRDRE ALLISON HABERMEHL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	G60299	CA
2	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	G60299	CA

General Provider Information

NPI Number	:	1023065570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEIRDRE ALLISON HABERMEHL M.D.

Provider Business Mailing Address
First Line	:	18800 MAIN ST
Second Line	:	STE 204
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-1707
Country	:	US
Telephone Number	:	949-548-6376
Fax Number	:	866-677-2855

Provider Business Practice Location Address
First Line	:	18800 MAIN ST
Second Line	:	STE 204
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-1707
Country	:	US
Telephone Number	:	949-548-6376
Fax Number	:	866-677-2855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	02/21/2017

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