Provider Demographics
NPI:1457024549
Name:DUDLEY, DAWN VICTORIA
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:VICTORIA
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6016 WHITSETT AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4536
Mailing Address - Country:US
Mailing Address - Phone:818-821-5684
Mailing Address - Fax:
Practice Address - Street 1:6016 WHITSETT AVE APT 9
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4536
Practice Address - Country:US
Practice Address - Phone:818-821-5684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management