Provider Demographics
NPI:1376350439
Name:JASSO, CLARA
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:JASSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 SE FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-1363
Mailing Address - Country:US
Mailing Address - Phone:503-358-3816
Mailing Address - Fax:
Practice Address - Street 1:18633 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5468
Practice Address - Country:US
Practice Address - Phone:503-489-1760
Practice Address - Fax:503-489-1763
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR112087172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty