Healthcare Provider Details

I. General information

NPI: 1730392903
Provider Name (Legal Business Name): MINERVA MARTINEZ CRUZ PH.D, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4609 SW 58TH LN
GAINESVILLE FL
32608-8826
US

IV. Provider business mailing address

4609 SW 58TH LN
GAINESVILLE FL
32608-8826
US

V. Phone/Fax

Practice location:
  • Phone: 352-494-0075
  • Fax:
Mailing address:
  • Phone: 352-494-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1677
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA3513
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-47249
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: