Memory Lane LLC

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

Legal business name

MEMORY LANE LLC

Practice address

1642 Lisa Ave
Vista, CA 92084-3054

Phone

(760) 536-3139

Fax

(760) 806-3582

NPI assigned

Oct 10, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amy Michelle Wombolt, CDP

Title

Owner

Phone

(760) 445-3639

Specialties & licenses 2

Addresses

Tax ID family

Memory Lane LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Memory Lane LLC

  • In Home Supportive Care Agency
  • Vista, CA
  • NPI 1922851435
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1760054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760054400000",
    "number": "1194690800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1642 LISA AVE",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920843054",
            "telephone_number": "760-445-3639",
            "fax_number": "760-806-3582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1642 LISA AVE",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920843054",
            "telephone_number": "760-536-3139",
            "fax_number": "760-806-3582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORY LANE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-10",
        "last_updated": "2025-10-10",
        "certification_date": "2025-10-10",
        "status": "A",
        "authorized_official_last_name": "WOMBOLT",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-445-3639",
        "authorized_official_credential": "CDP"
    },
    "taxonomies": [
        {
            "code": "372600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Adult Companion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine Melendez
• Melissa Hurd Medical Corporation
• Rebecca Mellman, PT
• Julia Lynn Mellusi, LCSW
• Melrose Square Dental Office
• Memory Lane LLC
• Cynthia Mendez Sanchez
• Christopher Raul Mendez
• Hailey Ashley Mendez
• Leslie Mendez

• Personal Care Attendant in Vista, CA
• Providers in Vista, CA by specialty
• Personal Care Attendant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.