Provider Demographics
NPI:1154590057
Name:DEIRDRE A. HABERMEHL, MD, INC.
Entity type:Organization
Organization Name:DEIRDRE A. HABERMEHL, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CHAVARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-548-6376
Mailing Address - Street 1:320 SUPERIOR AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2716
Mailing Address - Country:US
Mailing Address - Phone:949-548-6376
Mailing Address - Fax:949-548-6378
Practice Address - Street 1:320 SUPERIOR AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2716
Practice Address - Country:US
Practice Address - Phone:949-548-6376
Practice Address - Fax:949-548-6378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG60299BMedicare UPIN