Provider Demographics
NPI:1720699705
Name:MINDERA CORPORATION
Entity Type:Organization
Organization Name:MINDERA CORPORATION
Other - Org Name:MINDERA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CSO & CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TOBIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-810-6070
Mailing Address - Street 1:5795 KEARNY VILLA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1111
Mailing Address - Country:US
Mailing Address - Phone:858-810-6070
Mailing Address - Fax:
Practice Address - Street 1:5795 KEARNY VILLA RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1111
Practice Address - Country:US
Practice Address - Phone:858-810-6070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory