Healthcare Provider Details

I. General information

NPI: 1689581456
Provider Name (Legal Business Name): KATELYNN DUBOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6370 MAGNOLIA AVE STE 200
RIVERSIDE CA
92506-2406
US

IV. Provider business mailing address

30585 N GATE LN
MURRIETA CA
92563-2579
US

V. Phone/Fax

Practice location:
  • Phone: 951-257-9772
  • Fax:
Mailing address:
  • Phone: 951-257-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number10314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: