Provider Demographics
NPI:1467699231
Name:MONTALVO, MAHLA (LAC)
Entity Type:Individual
Prefix:DR
First Name:MAHLA
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613 N UNIVERSITY DR UNIT 399
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4602
Mailing Address - Country:US
Mailing Address - Phone:646-334-8818
Mailing Address - Fax:
Practice Address - Street 1:7401 WILES RD STE 227
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2038
Practice Address - Country:US
Practice Address - Phone:954-906-2379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003997171100000X
FL4139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist