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General NPI Number Information
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NPI Number | 1356630826
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Entity Type | Organization
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Legal Business Name | JOSEPH M. MAVICA.D.O. PA
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 2600 N MILITARY TRL SUITE 215
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City | BOCA RATON
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State | FL
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Zip | 33431-6312
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Country | US
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Telephone | 561-395-3778
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Fax | 561-395-5691
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Provider Business Mailing Address
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Address Line | 2600 N MILITARY TRL SUITE 215
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City | BOCA RATON
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State | FL
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Zip | 33431-6312
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Country | US
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Telephone | 561-395-3778
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Fax | 561-395-5691
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CAROL B MAVICA
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Credential |
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Telephone | 561-395-3778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | OS0006380
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License Number State | FL
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