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NPI 1376406397

NPI 1376406397 : RAYMOND BURKE C.R.A.T. : VENTURA, CA

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General NPI Number Information
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    NPI Number           |    1376406397
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    Entity Type          |    Individual 
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    Provider Name        |    RAYMOND BURKE C.R.A.T.
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    12/05/2025
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    Last Update Date     |    12/05/2025
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Provider Practice Location Address
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    Address Line         |    147 N BRENT ST 
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    City                 |    VENTURA
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    State                |    CA
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    Zip                  |    93003-2854
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    Country              |    US
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    Telephone            |    805-948-5013
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    147 N BRENT ST 
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    City                 |    VENTURA
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    State                |    CA
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    Zip                  |    93003-2854
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    Country              |    US
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    Telephone            |    805-948-5013
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    247200000X
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    Taxonomy Name        |    Other Technician
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    License Number       |    00135314
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    License Number State |    NC
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