Healthcare Provider Details

I. General information

NPI: 1295952810
Provider Name (Legal Business Name): KARENNA ANNE DICKERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26672 PORTOLA PKWY STE 108
FOOTHILL RANCH CA
92610-1773
US

IV. Provider business mailing address

26672 PORTOLA PKWY STE 108
FOOTHILL RANCH CA
92610-1773
US

V. Phone/Fax

Practice location:
  • Phone: 949-829-5533
  • Fax: 949-581-9158
Mailing address:
  • Phone: 949-829-5533
  • Fax: 949-581-9158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC146775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: