Basic Information
| Provider Information | |||||||||
| NPI: | 1760771182 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROESSLER-HENDERSON | ||||||||
| FirstName: | KATERI | ||||||||
| MiddleName: | MARIE | ||||||||
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| OtherLastName: | ROESSLER | ||||||||
| OtherFirstName: | KATERI | ||||||||
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| OtherCredential: | KATERI ROESSLER | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8707 FALMOUTH AVE UNIT 311 | ||||||||
| Address2: | |||||||||
| City: | PLAYA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902938298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4248350857 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4101 TORRANCE BLVD | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905034607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105407676 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2011 | ||||||||
| LastUpdateDate: | 04/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A126047 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | TP850 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.