Healthcare Provider Details

I. General information

NPI: 1427790765
Provider Name (Legal Business Name): ERIC EAVES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18818 US HIGHWAY 18
APPLE VALLEY CA
92307-2323
US

IV. Provider business mailing address

PO BOX 2087
APPLE VALLEY CA
92307-0040
US

V. Phone/Fax

Practice location:
  • Phone: 760-995-8949
  • Fax:
Mailing address:
  • Phone: 909-974-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: