# A&E PROFESSIONAL MEDICAL GROUP AND NURSING CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750017422
- **Authorized official:** EDEN DABALUS NP (SECRETARY)
- **Authorized official phone:** (310) 848-8865

## Contact information

- **Practice address:** 6816 PACIFIC BLVD STE 210, HUNTINGTON PARK, CA 90255-4654
- **Practice address phone:** (818) 754-7986
- **Mailing address:** 6816 PACIFIC BLVD, SUITE 210, HUNTINGTON PARK,, CA 90255-4654
- **Mailing address phone:** (818) 754-7986

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 07/26/2022
- **Last updated:** 08/03/2022