Individual ProviderJason DericoNaturopathOther Service ProvidersPractice Address4757 SW 141st Ave, Beaverton, OR 97005-3750(503) 610-6924(435) 764-7725PECOS EnrollmentBased on the most recent information from CMS, provider Jason Derico 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 ID1265804652Provider TypeIndividualFull NameDerico, JasonCredentialN.D.GenderMaleSole ProprietorYesEnumeration Date10/23/2015Last Updated10/23/2015Contact InformationPractice LocationPractice Address4757 SW 141st Ave, Beaverton, OR 97005-3750Phone(503) 610-6924FaxUnlisted FaxMailing LocationMailing Address4757 SW 141st Ave, Beaverton, OR 97005-3750Phone(435) 764-7725FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode175F00000XPrimaryDescriptionNaturopathOther Service ProvidersLicense3026Oregon