Provider Demographics
NPI:1760771182
Name:ROESSLER-HENDERSON, KATERI MARIE
Entity Type:Individual
Prefix:
First Name:KATERI
Middle Name:MARIE
Last Name:ROESSLER-HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATERI
Other - Middle Name:
Other - Last Name:ROESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KATERI ROESSLER
Mailing Address - Street 1:8707 FALMOUTH AVE UNIT 311
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8298
Mailing Address - Country:US
Mailing Address - Phone:424-835-0857
Mailing Address - Fax:
Practice Address - Street 1:4101 TORRANCE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4607
Practice Address - Country:US
Practice Address - Phone:310-540-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126047207P00000X
KYTP850207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine