Healthcare Provider Details

I. General information

NPI: 1558091850
Provider Name (Legal Business Name): MARQUINTA BURKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16650 SHERMAN WAY
VAN NUYS CA
91406-3782
US

IV. Provider business mailing address

11439 HELA AVE
LAKE VIEW TERRACE CA
91342-7237
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-4836
  • Fax:
Mailing address:
  • Phone: 818-581-9113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: