Provider Demographics
NPI:1184213340
Name:COBB, KATIE JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JEAN
Last Name:COBB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 RICARDO DR
Mailing Address - Street 2:
Mailing Address - City:AROMAS
Mailing Address - State:CA
Mailing Address - Zip Code:95004-9699
Mailing Address - Country:US
Mailing Address - Phone:661-600-7384
Mailing Address - Fax:
Practice Address - Street 1:2 LOWER RAGSDALE DR STE 160
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5840
Practice Address - Country:US
Practice Address - Phone:661-600-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59801207RI0011X, 2086S0129X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery