Provider Demographics
NPI:1336896752
Name:BURKA, HORDOFA GUNJA
Entity Type:Individual
Prefix:
First Name:HORDOFA
Middle Name:GUNJA
Last Name:BURKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 MCDOUGAL ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3061
Mailing Address - Country:US
Mailing Address - Phone:651-214-8859
Mailing Address - Fax:
Practice Address - Street 1:1519 MCDOUGAL ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3061
Practice Address - Country:US
Practice Address - Phone:651-214-8859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-05
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator