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1499 Se Tech Center Pl Ste 190 Vancouver WA 98683-5529 | |
| (360) 773-6340 | |
| (360) 326-2606 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1499 Se Tech Center Pl Ste 190, Vancouver, Washington |
| Authorized Official Name and Position | Oleg N Zbirun (CFO) |
| Authorized Official Contact | 4255077848 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
16420 Se Mcgillivray Blvd Ste 103-253 Vancouver WA 98683-3461 Ph: (425) 507-7848 | 1499 Se Tech Center Pl Ste 190 Vancouver WA 98683-5529 Ph: (360) 773-6340 |
| NPI Number | 1235765280 |
|---|---|
| Provider Enumeration Date | 03/20/2020 |
| Last Update Date | 02/03/2025 |
| Certification Date | 02/03/2025 |
| Medicare PECOS PAC ID | 5799148854 |
|---|---|
| Medicare Enrollment ID | O20230823001582 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235765280 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 2084P0802X | Psychiatry & Neurology - Addiction Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Elia R Gonzalez-rodriguez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609979558 PECOS PAC ID: 9537214374 Enrollment ID: I20110915000842 |
| Provider Name | Vaishali P Shah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184853483 PECOS PAC ID: 7618110016 Enrollment ID: I20180327002454 |
| Provider Name | Vanessa Ngea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114504768 PECOS PAC ID: 2961894878 Enrollment ID: I20240513000594 |
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