Provider Demographics
NPI:1629696976
Name:BURKS, TAJA
Entity Type:Individual
Prefix:
First Name:TAJA
Middle Name:
Last Name:BURKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19056 N TOLEDO AVE
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-2095
Mailing Address - Country:US
Mailing Address - Phone:480-309-9664
Mailing Address - Fax:
Practice Address - Street 1:19056 N TOLEDO AVE
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2095
Practice Address - Country:US
Practice Address - Phone:480-309-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care