Healthcare Provider Details

I. General information

NPI: 1215249149
Provider Name (Legal Business Name): CHRISTINA LEE BURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W GONZALES RD 102B
OXNARD CA
93036-3303
US

IV. Provider business mailing address

944 LIGHTHOUSE WAY
PORT HUENEME CA
93041-3511
US

V. Phone/Fax

Practice location:
  • Phone: 805-604-4430
  • Fax:
Mailing address:
  • Phone: 805-758-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 60149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: