Healthcare Provider Details

I. General information

NPI: 1366401028
Provider Name (Legal Business Name): MARIA D MARTINEZ-CRUZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7848 LAKE UNDERHILL RD
ORLANDO FL
32822-8227
US

IV. Provider business mailing address

7848 LAKE UNDERHILL RD
ORLANDO FL
32822-8227
US

V. Phone/Fax

Practice location:
  • Phone: 407-275-2676
  • Fax: 407-275-2681
Mailing address:
  • Phone: 407-275-2676
  • Fax: 407-275-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME58447
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: