Healthcare Provider Details

I. General information

NPI: 1174409833
Provider Name (Legal Business Name): KATERINA DOBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAROLINA SHOPP CT
CAROLINA PR
00985-5672
US

IV. Provider business mailing address

CAROLINA SHOPP CT
CAROLINA PR
00985-5672
US

V. Phone/Fax

Practice location:
  • Phone: 787-111-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002681
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: