Healthcare Provider Details

I. General information

NPI: 1376406397
Provider Name (Legal Business Name): RAYMOND BURKE C.R.A.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N BRENT ST
VENTURA CA
93003-2854
US

IV. Provider business mailing address

147 N BRENT ST
VENTURA CA
93003-2854
US

V. Phone/Fax

Practice location:
  • Phone: 805-948-5013
  • Fax:
Mailing address:
  • Phone: 805-948-5013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number00135314
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: