Healthcare Provider Details

I. General information

NPI: 1497782452
Provider Name (Legal Business Name): KATHARINE C DURSO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 WILSHIRE BLVD SUITE 250
BEVERLY HILLS CA
90211-3122
US

IV. Provider business mailing address

8530 WILSHIRE BLVD SUITE 250
BEVERLY HILLS CA
90211-3122
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-0366
  • Fax: 310-657-0466
Mailing address:
  • Phone: 310-657-0366
  • Fax: 310-657-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG65140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: