Healthcare Provider Details

I. General information

NPI: 1235765280
Provider Name (Legal Business Name): PACIFIC PHOENIX GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 SE TECH CENTER PL STE 190
VANCOUVER WA
98683-5529
US

IV. Provider business mailing address

16420 SE MCGILLIVRAY BLVD STE 103-253
VANCOUVER WA
98683-3461
US

V. Phone/Fax

Practice location:
  • Phone: 360-773-6340
  • Fax: 360-326-2606
Mailing address:
  • Phone: 425-507-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OLEG N ZBIRUN
Title or Position: CFO
Credential: MD
Phone: 425-507-7848