Provider Demographics
NPI:1497782452
Name:DURSO, KATHARINE C (MD)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:C
Last Name:DURSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8530 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3122
Mailing Address - Country:US
Mailing Address - Phone:310-657-0366
Mailing Address - Fax:310-657-0466
Practice Address - Street 1:8530 WILSHIRE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3122
Practice Address - Country:US
Practice Address - Phone:310-657-0366
Practice Address - Fax:310-657-0466
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65140173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19390Medicare ID - Type Unspecified