Basic Information
| Provider Information | |||||||||
| NPI: | 1114365822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ-ROMAN | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPARTMENT OF PSYCHIATRY | ||||||||
| Address2: | BOX 100256 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100256 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY OF FLORIDA 1600 SW ARCHER RD | ||||||||
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| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326103003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522657981 | ||||||||
| FaxNumber: | 3522657983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2013 | ||||||||
| LastUpdateDate: | 08/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 18852 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | JA770Z | 01 | MEDICARE PTAN | OTHER | 021315500 | 05 | FL | MEDICAID |