Healthcare Provider Details

I. General information

NPI: 1144069808
Provider Name (Legal Business Name): PACIFIC GASTRO HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8506 E MILL PLAIN BLVD STE B
VANCOUVER WA
98664-2021
US

IV. Provider business mailing address

PO BOX 873787
VANCOUVER WA
98687-3787
US

V. Phone/Fax

Practice location:
  • Phone: 360-823-0880
  • Fax: 360-823-0883
Mailing address:
  • Phone: 360-823-0880
  • Fax: 360-823-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARYAM FERDOWS
Title or Position: OFFICE MANAGER
Credential:
Phone: 360-823-0880