Healthcare Provider Details

I. General information

NPI: 1336146281
Provider Name (Legal Business Name): KAREN A KOVALOW-ST. JOHN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/14/2021
Certification Date: 03/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CASA ST STE 101
SAN LUIS OBISPO CA
93405-5804
US

IV. Provider business mailing address

8329 BRIMHALL RD STE 801
BAKERSFIELD CA
93312-2243
US

V. Phone/Fax

Practice location:
  • Phone: 661-695-8385
  • Fax: 661-679-6801
Mailing address:
  • Phone: 661-695-8385
  • Fax: 661-679-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number01037613A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: