Provider Demographics
NPI:1770579211
Name:GOODRICH, KAREN E (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:GOODRICH
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 1:1428 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
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82414207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A824140Medicaid
CA00A824140Medicaid