Provider Demographics
NPI:1093961757
Name:HAUSER, DEREK LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:LEE
Last Name:HAUSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5034 FEBRUARY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-1211
Mailing Address - Country:US
Mailing Address - Phone:661-317-7032
Mailing Address - Fax:
Practice Address - Street 1:5034 FEBRUARY ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-1211
Practice Address - Country:US
Practice Address - Phone:661-317-7032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10044207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine