Provider Demographics
NPI:1780889691
Name:DERIDDER, CATHERINE A (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:DERIDDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:M
Other - Last Name:ADRIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 W CARSON ST # 437
Mailing Address - Street 2:HARBOR-UCLA MEDICAL CENTER
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON ST # 437
Practice Address - Street 2:HARBOR-UCLA MEDICAL CENTER
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-2199
Practice Address - Fax:310-533-8579
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1119492080C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics