Healthcare Provider Details

I. General information

NPI: 1285075945
Provider Name (Legal Business Name): EDWIN E MWAKALINDILE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5153 N 9TH AVE 6TH FLOOR NEMOURS
PENSACOLA FL
32504-8785
US

IV. Provider business mailing address

5153 N 9TH AVE 6TH FLOOR NEMOURS
PENSACOLA FL
32504-8785
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-7658
  • Fax: 850-416-7677
Mailing address:
  • Phone: 850-416-7658
  • Fax: 850-416-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTRN18599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: