Provider Demographics
NPI:1225634157
Name:ENDEAVORS MEDICAL GROUP CORP.
Entity Type:Organization
Organization Name:ENDEAVORS MEDICAL GROUP CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C/ CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DABALUS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:702-891-0026
Mailing Address - Street 1:2700 E SUNSET RD STE 13
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3508
Mailing Address - Country:US
Mailing Address - Phone:702-891-0026
Mailing Address - Fax:702-895-7717
Practice Address - Street 1:2700 E SUNSET RD STE 13
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3508
Practice Address - Country:US
Practice Address - Phone:310-848-8865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty