Individual
JASON DERICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
N.D.
Contact information
Practice address
4757 SW 141ST AVE, BEAVERTON, OR 97005-3750
(503) 610-6924
Mailing address
4757 SW 141ST AVE, BEAVERTON, OR 97005-3750
(435) 764-7725
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
3026
OR
Other
Enumeration date
10/23/2015
Last updated
10/23/2015
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