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General NPI Number Information
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NPI Number | 1720699705
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Entity Type | Organization
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Legal Business Name | MINDERA CORPORATION
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 1221 LIBERTY WAY
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City | VISTA
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State | CA
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Zip | 92081-8368
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Country | US
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Telephone | 858-810-6070
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 LIBERTY WAY
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City | VISTA
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State | CA
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Zip | 92081-8368
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Country | US
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Telephone | 858-810-6070
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Fax |
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Authorized Official
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Title or Position | CSO & CO-FOUNDER
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Name | TOBIN J. DICKERSON
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Credential | PH.D.
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Telephone | 858-810-6070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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