MEDICARE: LATRICE MARIE BOOKER BSN, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	95450085	CA

General Provider Information

NPI Number	:	1356135032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATRICE MARIE BOOKER BSN, RN

Provider Business Mailing Address
First Line	:	710 E 60TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-3006
Country	:	US
Telephone Number	:	562-225-4644
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-5062
Country	:	US
Telephone Number	:	562-225-4644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/27/2026

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