Healthcare Provider Details

I. General information

NPI: 1043559859
Provider Name (Legal Business Name): DR. KAREN E. ANDERSON, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR SUITE 152
LA MESA CA
91942-3020
US

IV. Provider business mailing address

5565 GROSSMONT CENTER DR SUITE 152
LA MESA CA
91942-3020
US

V. Phone/Fax

Practice location:
  • Phone: 619-440-2202
  • Fax: 619-440-0502
Mailing address:
  • Phone: 619-440-2202
  • Fax: 619-440-0502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE3745
License Number StateCA

VIII. Authorized Official

Name: DR. KAREN E. ANDERSON
Title or Position: OWNER/PRESIDENT
Credential: DPM
Phone: 619-440-2202