Organization
NIDSA I MARTIR CRUZ MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NIDSA I MARTIR CRUZ MD (OWNER)
(352) 323-0888
Entity
Organization
Contact information
Practice address
26540 ACE AVE STE H103, LEESBURG, FL 34748-8279
(352) 323-0888
(352) 323-9103
Mailing address
PO BOX 490918, LEESBURG, FL 34749-0918
(352) 323-0888
(352) 323-9103
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME0063164
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371597300
—
FL
Enumeration date
09/22/2010
Last updated
06/05/2024
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