Provider Demographics
NPI:1710978713
Name:KOLBA, KAREN S (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:KOLBA
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 1:110 ERNA WAY
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3208
Mailing Address - Country:US
Mailing Address - Phone:805-925-8899
Mailing Address - Fax:805-922-5259
Practice Address - Street 1:607 E PLAZA DR
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-925-8899
Practice Address - Fax:805-922-5259
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59530207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G595300OtherBLUE SHIELD PIN
CAW14256Medicare PIN
CA00G595300OtherBLUE SHIELD PIN