Provider Demographics
NPI:1346594165
Name:LA FAYETTE, RICHARD TAMOTSU (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:TAMOTSU
Last Name:LA FAYETTE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 S STRATFORD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5908
Mailing Address - Country:US
Mailing Address - Phone:805-332-8446
Mailing Address - Fax:805-332-8173
Practice Address - Street 1:316 S STRATFORD AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5908
Practice Address - Country:US
Practice Address - Phone:805-332-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA259885164X00000X
CA95016427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164X00000XNursing Service ProvidersLicensed Vocational Nurse