=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649127440
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE PROFESSIONAL MEDICAL GROUP & NURSING CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2026
-----------------------------------------------------
Last Update Date | 03/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1539 W 158TH ST UNIT 4
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90247-3813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-848-8865
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1539 W 158TH ST UNIT 4
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90247-3813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-848-8865
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE OWNER
-----------------------------------------------------
Name | EDEN DABALUS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-848-8865
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------