Individual ProviderCassandra Diane WilsonBehavior TechnicianBehavioral Health & Social Service ProvidersPractice Address9620 Chesapeake Dr Ste 105, San Diego, CA 92123-1324(714) 834-1111PECOS EnrollmentBased on the most recent information from CMS, provider Cassandra Diane Wilson 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 ID1134900665Provider TypeIndividualFull NameWilson, Cassandra DianeGenderFemaleSole ProprietorNoEnumeration Date10/10/2023Last Updated10/10/2023Contact InformationPractice LocationPractice Address9620 Chesapeake Dr Ste 105, San Diego, CA 92123-1324Phone(714) 834-1111FaxUnlisted FaxMailing LocationMailing Address9620 Chesapeake Dr Ste 105, San Diego, CA 92123-1324Phone(714) 834-1111FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106S00000XPrimaryDescriptionBehavior TechnicianBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer