Provider Demographics
NPI:1477061232
Name:DABALUS, EDEN B (NP)
Entity Type:Individual
Prefix:MRS
First Name:EDEN
Middle Name:B
Last Name:DABALUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 SEPULVEDA BLVD APT 614
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3462
Mailing Address - Country:US
Mailing Address - Phone:310-848-8865
Mailing Address - Fax:
Practice Address - Street 1:1309 SEPULVEDA BLVD APT 614
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3462
Practice Address - Country:US
Practice Address - Phone:310-848-8865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily