| NPI | 1124123534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIO S RODRIGUEZ Manager 813-386-6800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY6792) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY6274) |
| 103T00000X Psychologist (Licence: FL PY6420) | |
| 103TH0100X Psychologist Health Service (Licence: FL PY6377) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2013-05-10 |