Provider Demographics
NPI:1992879803
Name:MAVICA, JOESPH MARK (DO)
Entity type:Individual
Prefix:DR
First Name:JOESPH
Middle Name:MARK
Last Name:MAVICA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:18269 FRESH LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-1950
Mailing Address - Country:US
Mailing Address - Phone:561-395-3778
Mailing Address - Fax:561-395-5691
Practice Address - Street 1:2600 NORTH MILITARY TRAIL
Practice Address - Street 2:SUITE 215
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-395-3778
Practice Address - Fax:561-395-5691
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0500063802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9125960OtherAETNA
FL1529773OtherVBH
FL9125960OtherAETNA