Basic Information
| Provider Information | |||||||||
| NPI: | 1558091850 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKS | ||||||||
| FirstName: | MARQUINTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11439 HELA AVE | ||||||||
| Address2: | |||||||||
| City: | LAKE VIEW TERRACE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913427237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185819113 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16650 SHERMAN WAY | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914063782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189014836 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2022 | ||||||||
| LastUpdateDate: | 06/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 84908 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.