Provider Demographics
NPI:1669938536
Name:PAN PACIFIC HEALTH PPLC
Entity type:Organization
Organization Name:PAN PACIFIC HEALTH PPLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LIISA
Authorized Official - Middle Name:ELINA
Authorized Official - Last Name:DURCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-484-7701
Mailing Address - Street 1:509 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1551
Mailing Address - Country:US
Mailing Address - Phone:206-484-7701
Mailing Address - Fax:
Practice Address - Street 1:10634 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3757
Practice Address - Country:US
Practice Address - Phone:206-484-7701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty