Provider Demographics
NPI:1386491496
Name:DUDAMEL, KATHERINE VANESSA (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:VANESSA
Last Name:DUDAMEL
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 1:1911 HOLCOMBE BLVD APT 2002
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4194
Mailing Address - Country:US
Mailing Address - Phone:863-605-2886
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN STREET
Practice Address - Street 2:MSB 1.134
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-500-6526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty