Provider Demographics
NPI:1447414974
Name:KAREN E. GOODRICH, M.D. INC.
Entity Type:Organization
Organization Name:KAREN E. GOODRICH, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:GOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-598-2827
Mailing Address - Street 1:1428 PHILLIPS LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2537
Mailing Address - Country:US
Mailing Address - Phone:805-548-8545
Mailing Address - Fax:805-548-8548
Practice Address - Street 1:1428 PHILLIPS LN
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2537
Practice Address - Country:US
Practice Address - Phone:805-548-8545
Practice Address - Fax:805-548-8548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82414207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty