Individual provider Active NPI

Edrick Mathieu Oteyza, NP

  • Nurse Practitioner
  • Stanford, CA
National Provider Identifier
1619640141
Registry record updated Aug 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95017112 Issued in CA
Practice address
300 Pasteur Dr
Stanford, CA 94305-2200
Phone
(650) 723-4000
NPI assigned
Jul 29, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95078590 CA
Nurse Practitioner 363L00000X 95017112 CA Primary

Addresses

Primary practice location

300 Pasteur Dr
Stanford, CA 94305-2200

Mailing address

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000

Other practice location 1

1200 B Gale Wilson Blvd
Fairfield, CA 94533-3587
Phone (707) 646-3333

Other identifiers 2

IdentifierTypeStateIssuer
95017112OtherCANURSE PRACTITIONER FURNISHING
95078590OtherCAREGISTERED NURSE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240923000502 CA Practitioner - Nurse Practitioner 3375084098 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95078590CAMDRegistered Nurse
95017112CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northbay Healthcare Group Current Accepting new patients
Northbay Healthcare Group CurrentSince Jun 14, 2024 Accepting new patients
Northbay Health Medical Foundation CurrentSince Jan 1, 2026 Accepting new patients
Northbay Physicians Surgery Center LLC Past Accepting new patients

Locations

1200 B Gale Wilson Blvd
Fairfield, CA 94533
Phone (707) 429-3600

1860 Pennsylvania Ave
Ste 110
Fairfield, CA 94533
Phone (707) 254-9693

1860 Pennsylvania Ave
Ste 320
Fairfield, CA 94533
Phone (707) 260-5719

4500 Business Center Dr
Fairfield, CA 94534
Phone (707) 646-4777

1000 Nut Tree Rd
Vacaville, CA 95687
Phone (707) 446-4000

1010 Nut Tree Rd
Ste 100B
Vacaville, CA 95687
Phone (707) 646-7999

101 Main St
Winters, CA 95694
Phone (530) 795-4123

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/UMZ-Uxn6V9x08sH5gCnG-5yPg9ZX7et6/

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786924800000",
    "number": "1619640141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 B Gale Wilson Blvd",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "CA",
            "postal_code": "945333587",
            "country_code": "US",
            "telephone_number": "707-646-3333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OTEYZA",
        "first_name": "EDRICK",
        "middle_name": "MATHIEU",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-29",
        "last_updated": "2026-08-17",
        "certification_date": "2026-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95078590",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95017112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER FURNISHING",
            "identifier": "95017112",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED NURSE LICENSE",
            "identifier": "95078590",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanford, CA

Sources for this page

Verify at the official NPI Registry.