MEDICARE: AHMAD JAFFAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1194403071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHMAD JAFFAS

Provider Business Mailing Address
First Line	:	7931 NE HALSEY ST STE 200
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-6755
Country	:	US
Telephone Number	:	503-231-7480
Fax Number	:

Provider Business Practice Location Address
First Line	:	7931 NE HALSEY ST STE 200
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-6755
Country	:	US
Telephone Number	:	503-231-7480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/11/2023

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