Healthcare Provider Details

I. General information

NPI: 1457162034
Provider Name (Legal Business Name): VINCETTA MENDOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14223 CALIFA ST
VAN NUYS CA
91401-3613
US

IV. Provider business mailing address

14400 CHANDLER BLVD APT 205
SHERMAN OAKS CA
91401-5525
US

V. Phone/Fax

Practice location:
  • Phone: 818-669-9411
  • Fax:
Mailing address:
  • Phone: 818-669-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number332789064
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: