Provider Information for 1265872279
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Mr. EDUARDO CALATAYUD IV M.A.
Sex: Male
NPI: 1265872279
Last Updated: 2021-03-25
Certification Date: 2021-03-25
Certification Date: 2021-03-25
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1265872279 | ||||||||||||||
| Enumeration Date | 2013-07-05 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 38728 ANNETTE AVE PALMDALE, CA 93551-5409 United States Phone: 661-965-4261 | Fax: | ||||||||||||||
| Primary Practice Address | 28700 BOUQUET CANYON RD SANTA CLARITA, CA 91390-1220 United States Phone: 661-965-4261 | Fax: | ||||||||||||||
| Secondary Practice Address(es) | 44447 10TH ST W | ||||||||||||||
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