Active NPI
Eric Franz Evenhuis, MFT
- Specialist
- Alta Loma, CA
National Provider Identifier
1114112455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MFC-13882
- Practice address
- 6113 Kirkwood Ave
Alta Loma, CA 91701-3417 - Phone
- (909) 980-5900
- Fax
- (909) 466-4203
- NPI assigned
- Sep 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MFC-13882 | CA | Primary |
Addresses
Primary practice location
6113 Kirkwood Ave
Alta Loma, CA 91701-3417
Mailing address
10808 Foothill Blvd
160-427
Rancho Cucamonga, CA 91730-3889
Phone (909) 481-5800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MFC13882061907 | Other | CA | SERVICE LOCATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC-13882 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189382400000",
"number": "1114112455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10808 FOOTHILL BLVD",
"address_2": "160-427",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917303889",
"telephone_number": "909-481-5800",
"fax_number": "909-481-5872"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6113 KIRKWOOD AVE",
"city": "ALTA LOMA",
"state": "CA",
"postal_code": "917013417",
"telephone_number": "909-980-5900",
"fax_number": "909-466-4203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVENHUIS",
"first_name": "ERIC",
"middle_name": "FRANZ",
"name_prefix": "Prof.",
"credential": "MFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-10",
"last_updated": "2007-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "MFC-13882",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SERVICE LOCATION",
"identifier": "MFC13882061907",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Alta Loma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.