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General NPI Number Information
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NPI Number | 1861572653
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Entity Type | Individual
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Provider Name | EDWIN MANUEL VILLALOBOS M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 2692 W LAKE MARY BLVD
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City | LAKE MARY
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State | FL
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Zip | 32746-3535
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Country | US
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Telephone | 321-710-8027
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Fax | 407-333-9974
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Provider Business Mailing Address
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Address Line | 5365 W ATLANTIC AVE SUITE 504
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City | DELRAY BEACH
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State | FL
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Zip | 33484-8172
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Country | US
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Telephone | 561-241-9300
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Fax | 561-241-9339
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD0000059994
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME44332
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License Number State | FL
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Taxonomy #3
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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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