Provider Demographics
NPI:1346275369
Name:MARTIR CRUZ, NIDSA I (MD)
Entity Type:Individual
Prefix:DR
First Name:NIDSA
Middle Name:I
Last Name:MARTIR CRUZ
Suffix:
Gender:F
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:PO BOX 490918
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-0918
Mailing Address - Country:US
Mailing Address - Phone:352-323-0888
Mailing Address - Fax:352-323-9103
Practice Address - Street 1:4700 VIA DEL MEDICO
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-9723
Practice Address - Country:US
Practice Address - Phone:352-323-0888
Practice Address - Fax:352-323-9103
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME631642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371597300Medicaid
FL130012170OtherRAILROAD MEDICARE
FL130012170OtherRAILROAD MEDICARE
FL18153Medicare ID - Type Unspecified