Individual
EDRICK MATHIEU OTEYZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1200 B GALE WILSON BLVD, FAIRFIELD, CA 94533-3587
(707) 646-3333
Mailing address
1484 LEGACY LN, FAIRFIELD, CA 94533-7151
(707) 334-7953
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95078590
CA
363L00000X
Nurse Practitioner
Primary
95017112
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95017112
NURSE PRACTITIONER FURNISHING
CA
01
—
95078590
REGISTERED NURSE LICENSE
CA
Enumeration date
07/29/2021
Last updated
07/29/2021
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