=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972401222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAMOTSU NURSING CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2026
-----------------------------------------------------
Last Update Date | 11/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 1ST AVE STE 1A
-----------------------------------------------------
City | SAN MATEO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94401-3476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-413-7424
-----------------------------------------------------
Fax | 866-746-8986
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7395 EL CAMINO REAL # 517
-----------------------------------------------------
City | ATASCADERO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93422-4628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-413-7424
-----------------------------------------------------
Fax | 866-746-8986
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | RICHARD TAMOTSU LA FAYETTE
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 858-413-7424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------