Dr Jaclyn Renee Derosso, AUD is a
Audiologist based in Reseda, California. Dr Jaclyn Renee Derosso is licensed to practice in Oregon (license number 30928) and her current practice location is
18040 Sherman Way, Reseda, California. She can be reached at her office (for appointments etc.) via phone at
(503) 997-4669.
NPI number for Dr Jaclyn Renee Derosso is 1184186447 and her current mailing address is 5309 Sw Multnomah Blvd, Portland, Oregon. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1184186447.
Healthcare Provider's Profile
| Full Name | Dr Jaclyn Renee Derosso |
|---|
| Gender | Female |
|---|
| Speciality | Audiologist |
|---|
| Location | 18040 Sherman Way, Reseda, California |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1184186447
- Provider Enumeration Date: 04/04/2019
- Last Update Date: 10/13/2020
Medical Identifiers
Medical identifiers for Dr Jaclyn Renee Derosso such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1184186447 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 231H00000X | Audiologist | 30928 (Oregon) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jaclyn Renee Derosso is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Jaclyn Renee Derosso, AUD
5309 Sw Multnomah Blvd,
Portland, OR 97219-3345
Ph: (541) 979-2344 | Dr Jaclyn Renee Derosso, AUD
18040 Sherman Way,
Reseda, CA 91335-4631
Ph: (503) 997-4669 |
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