Individual ProviderRoxana MandisenSocial WorkerBehavioral Health & Social Service ProvidersPractice Address232 E Gish Rd, San Jose, CA 95112-4706(408) 876-4284PECOS EnrollmentBased on the most recent information from CMS, provider Roxana Mandisen 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 ID1245799972Provider TypeIndividualFull NameMandisen, RoxanaGenderFemaleSole ProprietorNoEnumeration Date3/12/2019Last Updated3/7/2024Contact InformationPractice LocationPractice Address232 E Gish Rd, San Jose, CA 95112-4706Phone(408) 876-4284FaxUnlisted FaxMailing LocationMailing Address232 E Gish Rd, San Jose, CA 95112-4706Phone(408) 876-4284FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode104100000XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense109241California