Healthcare Provider Details

I. General information

NPI: 1548979370
Provider Name (Legal Business Name): EDWARD HASSAN MUWWAKKIL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 POINSETTIA CIR
CALIMESA CA
92320-4918
US

IV. Provider business mailing address

14700 MANZANITA PARK RD
BEAUMONT CA
92223
US

V. Phone/Fax

Practice location:
  • Phone: 909-231-3172
  • Fax:
Mailing address:
  • Phone: 951-845-3155
  • Fax: 951-845-8412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberDA48802232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: