Provider Demographics
NPI:1265872279
Name:CALATAYUD, EDUARDO IV (MA)
Entity type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:
Last Name:CALATAYUD
Suffix:IV
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38728 ANNETTE AVE
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5409
Mailing Address - Country:US
Mailing Address - Phone:661-965-4261
Mailing Address - Fax:
Practice Address - Street 1:28700 BOUQUET CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-1220
Practice Address - Country:US
Practice Address - Phone:661-965-4261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA99269106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265872279Medicaid