Provider Demographics
NPI:1891468054
Name:EDEN INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:EDEN INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:954-906-2379
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 # 227
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2036
Practice Address - Country:US
Practice Address - Phone:954-906-2379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty