MEDICARE: VINCETTA MENDOLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	332789064	CA
2	374U00000X	Home Health Aide		CA

General Provider Information

NPI Number	:	1457162034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCETTA MENDOLA

Provider Business Mailing Address
First Line	:	14400 CHANDLER BLVD APT 205
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-5525
Country	:	US
Telephone Number	:	818-669-9411
Fax Number	:

Provider Business Practice Location Address
First Line	:	14223 CALIFA ST
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-3613
Country	:	US
Telephone Number	:	818-669-9411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	05/28/2026

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Directions to “ VINCETTA MENDOLA ” Practice Location

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