Healthcare Provider Details

I. General information

NPI: 1154210219
Provider Name (Legal Business Name): JAYDEN JOSEPH NAVARRO PSS PWS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24050 SE STARK ST APT 1003
GRESHAM OR
97030-3172
US

IV. Provider business mailing address

24050 SE STARK ST
GRESHAM OR
97030-3219
US

V. Phone/Fax

Practice location:
  • Phone: 971-712-8381
  • Fax:
Mailing address:
  • Phone: 971-712-8381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: