Healthcare Provider Details

I. General information

NPI: 1164008199
Provider Name (Legal Business Name): KATHERINE MARIE DUDLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 RUFFIN RD
SAN DIEGO CA
92123-1810
US

IV. Provider business mailing address

3626 RUFFIN RD
SAN DIEGO CA
92123-1810
US

V. Phone/Fax

Practice location:
  • Phone: 858-565-9666
  • Fax: 858-565-9441
Mailing address:
  • Phone: 858-565-9666
  • Fax: 858-565-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA201690
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: