Provider Demographics
NPI:1689978652
Name:ALAMUTU, OMOTAYO O (DNP, FNP, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:OMOTAYO
Middle Name:O
Last Name:ALAMUTU
Suffix:
Gender:F
Credentials:DNP, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2297
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95696-8297
Mailing Address - Country:US
Mailing Address - Phone:707-448-6841
Mailing Address - Fax:
Practice Address - Street 1:1600 CALIFORNIA DRIVE
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687
Practice Address - Country:US
Practice Address - Phone:707-448-6841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19624363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner