Provider Demographics
NPI:1144918608
Name:LOMBERE, MINDY MICHELLE
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:MICHELLE
Last Name:LOMBERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30688 BLOOMSBURY LN
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-2581
Mailing Address - Country:US
Mailing Address - Phone:760-855-5992
Mailing Address - Fax:
Practice Address - Street 1:33 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:GA
Practice Address - Zip Code:31635-5716
Practice Address - Country:US
Practice Address - Phone:229-482-1100
Practice Address - Fax:229-482-1103
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GADN123100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program