NPIMap

Organization Active NPI

Florida Medical Psychology Associates, LLC

  • Clinical Psychologist
  • Tampa, FL
National Provider Identifier
1124123534
Registry record updated May 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY6792 Issued in FL
Legal business name
FLORIDA MEDICAL PSYCHOLOGY ASSOCIATES, LLC
Practice address
12167 W. Linebaugh Ave.
Tampa, FL 33626-4615
Phone
(813) 386-6800
Fax
(813) 891-1311
NPI assigned
Sep 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mario S Rodriguez, PH.D.
Title
Manager
Phone
(813) 386-6800

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X PY6274 FL
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X PY6420 FL
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PY6792 FL Primary
Health Service PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TH0100X PY6377 FL

Addresses

Primary practice location

12167 W. Linebaugh Ave.
Tampa, FL 33626-4615

Mailing address

12167 W. Linebaugh Ave.
Tampa, FL 33626
Phone (813) 386-6800

National Provider Directory

National Provider Directory

Locations

12167 W Linebaugh Ave
Tampa, FL 33626
Phone (813) 386-6800

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368144000000",
    "number": "1124123534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12167 W. LINEBAUGH AVE.",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33626",
            "telephone_number": "813-386-6800",
            "fax_number": "813-891-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12167 W. LINEBAUGH AVE.",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336264615",
            "telephone_number": "813-386-6800",
            "fax_number": "813-891-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA MEDICAL PSYCHOLOGY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2013-05-10",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "813-386-6800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY6274",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY6420",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY6792",
            "primary": true
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Health Service",
            "state": "FL",
            "license": "PY6377",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.