Individual ProviderLarisa M ShevchukBehavior TechnicianBehavioral Health & Social Service ProvidersPractice Address9620 Chesapeake Dr Ste 105, San Diego, CA 92123-1324(858) 505-9083PECOS EnrollmentBased on the most recent information from CMS, provider Larisa M Shevchuk 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 yesterday at 12:57 PM.Profile DetailsProvider ID1013694009Provider TypeIndividualFull NameShevchuk, Larisa MGenderFemaleSole ProprietorNoEnumeration Date6/30/2023Last Updated6/30/2023Contact InformationPractice LocationPractice Address9620 Chesapeake Dr Ste 105, San Diego, CA 92123-1324Phone(858) 505-9083FaxUnlisted FaxMailing LocationMailing Address9620 Chesapeake Dr Ste 105, San Diego, CA 92123-1324Phone(858) 505-9083FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106S00000XPrimaryDescriptionBehavior TechnicianBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCaliforniaCode103K00000XDescriptionBehavior AnalystBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCalifornia