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General NPI Number Information
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NPI Number | 1235765280
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Entity Type | Organization
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Legal Business Name | PACIFIC PHOENIX GROUP PLLC
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1499 SE TECH CENTER PL STE 190
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City | VANCOUVER
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State | WA
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Zip | 98683-5529
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Country | US
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Telephone | 360-773-6340
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Fax | 360-326-2606
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Provider Business Mailing Address
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Address Line | 16420 SE MCGILLIVRAY BLVD STE 103-253
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City | VANCOUVER
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State | WA
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Zip | 98683-3461
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Country | US
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Telephone | 425-507-7848
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | DR. OLEG N ZBIRUN
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Credential | MD
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Telephone | 425-507-7848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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