Healthcare Provider Details

I. General information

NPI: 1760518179
Provider Name (Legal Business Name): LUCY EADS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 E LATHAM AVE
HEMET CA
92543-4445
US

IV. Provider business mailing address

1963 N E ST
SAN BERNARDINO CA
92405-3919
US

V. Phone/Fax

Practice location:
  • Phone: 951-925-6625
  • Fax: 951-658-0775
Mailing address:
  • Phone: 909-881-6146
  • Fax: 909-881-3479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number94028011
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA18333
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: