Provider Demographics
NPI:1003311846
Name:ISOKE, LATRICE MONIQUE
Entity Type:Individual
Prefix:MS
First Name:LATRICE
Middle Name:MONIQUE
Last Name:ISOKE
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 1:2655 CAMINO DEL RIO N STE 450
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1603
Mailing Address - Country:US
Mailing Address - Phone:858-633-4115
Mailing Address - Fax:
Practice Address - Street 1:2655 CAMINO DEL RIO N STE 450
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1603
Practice Address - Country:US
Practice Address - Phone:858-633-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 174400000X, 172V00000X
CAEMPLOYMENT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist