| Nidsa I Martir Cruz Md Pa | |
|
26540 Ace Ave Ste H103 Leesburg FL 34748-8279 | |
| (352) 323-0888 | |
| (352) 323-9103 |
| Full Name | Nidsa I Martir Cruz Md Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 26540 Ace Ave Ste H103, Leesburg, Florida |
| Authorized Official Name and Position | Nidsa I Martir Cruz (OWNER) |
| Authorized Official Contact | 3523230888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nidsa I Martir Cruz Md Pa Po Box 490918 Leesburg FL 34749-0918 Ph: (352) 323-0888 | Nidsa I Martir Cruz Md Pa 26540 Ace Ave Ste H103 Leesburg FL 34748-8279 Ph: (352) 323-0888 |
| NPI Number | 1356659502 |
|---|---|
| Provider Enumeration Date | 09/22/2010 |
| Last Update Date | 06/05/2024 |
| Certification Date | 06/05/2024 |
| Medicare PECOS PAC ID | 7517159288 |
|---|---|
| Medicare Enrollment ID | O20101013000633 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356659502 | NPI | - | NPPES |
| 371597300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | ME0063164 (Florida) | Primary |
| Provider Name | Nidsa Ivette Martir Cruz |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1346275369 PECOS PAC ID: 0941492623 Enrollment ID: I20101013000702 |
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