Provider Demographics
NPI:1124561592
Name:DE LA CRUZ MARTINEZ, JAVIER AMHED (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:AMHED
Last Name:DE LA CRUZ MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8327 W ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7452
Mailing Address - Country:US
Mailing Address - Phone:954-755-2468
Mailing Address - Fax:
Practice Address - Street 1:8327 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7452
Practice Address - Country:US
Practice Address - Phone:954-755-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020006793207R00000X, 208M00000X
FLME133427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist