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General NPI Number Information
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NPI Number | 1225634157
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Entity Type | Organization
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Legal Business Name | ENDEAVORS MEDICAL GROUP CORP.
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Dates
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Enumeration Date | 12/07/2020
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 2700 E SUNSET RD STE 13
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City | LAS VEGAS
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State | NV
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Zip | 89120-3508
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Country | US
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Telephone | 310-848-8865
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 E SUNSET RD STE 13
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City | LAS VEGAS
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State | NV
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Zip | 89120-3508
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Country | US
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Telephone | 702-891-0026
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Fax | 702-895-7717
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Authorized Official
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Title or Position | FNP-C/ CEO
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Name | MRS. EDEN DABALUS
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Credential | FNP-C
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Telephone | 702-891-0026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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