Healthcare Provider Details

I. General information

NPI: 1265163364
Provider Name (Legal Business Name): KATHERINE BOWLIN MS, DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MISSION ST
SANTA CRUZ CA
95060-3530
US

IV. Provider business mailing address

1301 MISSION ST
SANTA CRUZ CA
95060-3530
US

V. Phone/Fax

Practice location:
  • Phone: 831-458-6310
  • Fax: 831-458-6315
Mailing address:
  • Phone: 831-458-6300
  • Fax: 831-458-6305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A25789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: