Provider Demographics
NPI:1245779818
Name:CRUZ MARTIR, MAYREDLIS (DC)
Entity Type:Individual
Prefix:
First Name:MAYREDLIS
Middle Name:
Last Name:CRUZ MARTIR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HILDEN RD
Mailing Address - Street 2:STE 123
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-8401
Mailing Address - Country:US
Mailing Address - Phone:254-220-1078
Mailing Address - Fax:
Practice Address - Street 1:148 SPLIT OAK RD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-5444
Practice Address - Country:US
Practice Address - Phone:254-220-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor