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General NPI Number Information
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NPI Number | 1124216601
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Entity Type | Organization
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Legal Business Name | EDWIN M VILLALOBOS MD PA
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 661 E ALTAMONTE DR SUITE 231
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-5105
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Country | US
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Telephone | 407-331-0771
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Fax | 407-331-0577
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Provider Business Mailing Address
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Address Line | 661 E ALTAMONTE DR SUITE 231
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-5105
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Country | US
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Telephone | 407-331-0771
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Fax | 407-331-0577
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWIN M. VILLALOBOS
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Credential | M.D.
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Telephone | 407-331-0771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9101382
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME44332
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License Number State | FL
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