Provider Demographics
NPI:1023065570
Name:HABERMEHL, DEIRDRE ALLISON (MD)
Entity type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:ALLISON
Last Name:HABERMEHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18800 MAIN ST
Mailing Address - Street 2:STE 204
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1707
Mailing Address - Country:US
Mailing Address - Phone:949-548-6376
Mailing Address - Fax:866-677-2855
Practice Address - Street 1:18800 MAIN ST
Practice Address - Street 2:STE 204
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1707
Practice Address - Country:US
Practice Address - Phone:949-548-6376
Practice Address - Fax:866-677-2855
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60299207V00000X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG60299Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION