Provider Demographics
NPI:1497100952
Name:MARTINEZ CRUZ, JEAN CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:CARLOS
Last Name:MARTINEZ CRUZ
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 1:1050 W CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-1268
Mailing Address - Country:US
Mailing Address - Phone:407-518-0078
Mailing Address - Fax:407-518-0094
Practice Address - Street 1:1050 W CARROLL ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-518-0078
Practice Address - Fax:407-518-0094
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1153208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice