Healthcare Provider Details

I. General information

NPI: 1184887408
Provider Name (Legal Business Name): CATHERINE ANNE RIDGWAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR UCSD REGIONAL BURN CENTER
SAN DIEGO CA
92103-9001
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6001
  • Fax: 619-543-6003
Mailing address:
  • Phone: 619-543-2746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17175
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA17175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: