Individual ProviderDianna MendozaLicensed Practical NurseNursing Service ProvidersPractice Address42 Mowbray St, Patchogue, NY 11772-2114(631) 690-3157PECOS EnrollmentBased on the most recent information from CMS, provider Dianna Mendoza does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1720767478Provider TypeIndividualFull NameMendoza, DiannaGenderFemaleSole ProprietorNoEnumeration Date7/11/2023Last Updated7/11/2023Contact InformationPractice LocationPractice Address42 Mowbray St, Patchogue, NY 11772-2114Phone(631) 690-3157FaxUnlisted FaxMailing LocationMailing Address42 Mowbray St, Patchogue, NY 11772-2114Phone(631) 690-3157FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense346625-01New York