Healthcare Provider Details

I. General information

NPI: 1528505401
Provider Name (Legal Business Name): ZAUROV PSYCHIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3787 RIVER RD NORTH SUITE A
KEIZER OR
97303
US

IV. Provider business mailing address

3787 RIVER RD NORTH SUITE A
KEIZER OR
97303
US

V. Phone/Fax

Practice location:
  • Phone: 971-599-3411
  • Fax: 971-999-0906
Mailing address:
  • Phone: 971-599-3411
  • Fax: 971-999-0906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number201700160RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number201700161NP-PP
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201700161NP-PP
License Number StateOR

VIII. Authorized Official

Name: MICHAEL ZAUROV
Title or Position: OWNER
Credential: PMHNP
Phone: 971-599-3411