Provider Demographics
NPI:1669290060
Name:MINCY, YVONNE LYNETTE
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:LYNETTE
Last Name:MINCY
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 1:640 S SAN VICENTE BLVD STE 441
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4654
Mailing Address - Country:US
Mailing Address - Phone:323-244-3322
Mailing Address - Fax:
Practice Address - Street 1:640 S SAN VICENTE BLVD STE 441
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4654
Practice Address - Country:US
Practice Address - Phone:323-244-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAKK428331224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist