# MR. EDUARDO M AZCARATE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1164771895
- **Gender:** Man
- **Credential:** PHD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | 0810000952 | VA | Yes |

## Other

- **Enumeration date:** 09/10/2012
- **Last updated:** 09/10/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 12299964 | CAQH | — |