Provider Demographics
NPI:1255174538
Name:CRUZ-MARTINEZ, ONELIZ
Entity type:Individual
Prefix:
First Name:ONELIZ
Middle Name:
Last Name:CRUZ-MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27324 DORTCH AVE
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-5579
Mailing Address - Country:US
Mailing Address - Phone:239-465-3645
Mailing Address - Fax:
Practice Address - Street 1:20 BARKLEY CIR STE 201
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4545
Practice Address - Country:US
Practice Address - Phone:239-245-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104875225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty