Healthcare Provider Details

I. General information

NPI: 1356135032
Provider Name (Legal Business Name): LATRICE MARIE BOOKER BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 LONG BEACH BLVD
LONG BEACH CA
90807-5062
US

IV. Provider business mailing address

710 E 60TH ST
LONG BEACH CA
90805-3006
US

V. Phone/Fax

Practice location:
  • Phone: 562-225-4644
  • Fax:
Mailing address:
  • Phone: 562-225-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95450085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: