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General NPI Number Information
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NPI Number | 1376782441
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Entity Type | Organization
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Legal Business Name | JOHN P MIHALOVICH PHD PA
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Dates
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Enumeration Date | 02/13/2009
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Last Update Date | 02/13/2009
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Provider Practice Location Address
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Address Line | 2850 SE CALVIN ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5808
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Country | US
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Telephone | 772-370-9836
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Fax | 772-871-7822
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Provider Business Mailing Address
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Address Line | 2850 SE CALVIN ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5808
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Country | US
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Telephone | 772-370-9836
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Fax | 772-871-7822
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN P MIHALOVICH
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Credential | PHD
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Telephone | 772-370-9836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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