Organization
FLORIDA MEDICAL PSYCHOLOGY ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIO S RODRIGUEZ PH.D. (MANAGER)
(813) 386-6800
Entity
Organization
Contact information
Practice address
12167 W. LINEBAUGH AVE., TAMPA, FL 33626-4615
(813) 386-6800
(813) 891-1311
Mailing address
12167 W. LINEBAUGH AVE., TAMPA, FL 33626
(813) 386-6800
(813) 891-1311
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PY6274
FL
103T00000X
Psychologist
PY6420
FL
103TC0700X
Clinical Psychologist
Primary
PY6792
FL
103TH0100X
Health Service Psychologist
PY6377
FL
Other
Enumeration date
09/13/2006
Last updated
05/10/2013
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