Healthcare Provider Details

I. General information

NPI: 1649127440
Provider Name (Legal Business Name): HOPE PROFESSIONAL MEDICAL GROUP & NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 ROSECRANS AVE STE 5200
EL SEGUNDO CA
90245-4936
US

IV. Provider business mailing address

2321 ROSECRANS AVE STE 5200
EL SEGUNDO CA
90245-4936
US

V. Phone/Fax

Practice location:
  • Phone: 213-537-6956
  • Fax: 310-868-2763
Mailing address:
  • Phone: 213-537-6956
  • Fax: 310-868-2763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDEN DABALUS
Title or Position: PRACTICE OWNER
Credential:
Phone: 310-848-8865