Basic Information
| Provider Information | |||||||||
| NPI: | 1124081237 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ-MARTINEZ | ||||||||
| FirstName: | EDGARDO | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 SE MAGNOLIA EXT | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344714463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526291800 | ||||||||
| FaxNumber: | 3526291888 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 SE MAGNOLIA EXT | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344714463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526291800 | ||||||||
| FaxNumber: | 3526291888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 12/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME78169 | FL | N | Other Service Providers | Specialist | 2084N0400X | ME78169 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 281123500 | 05 | FL | MEDICAID | 5482350 | 01 | FL | FIRST HEALTH | OTHER | 35563 | 01 | FL | BCBS | OTHER | 274278 | 01 | FL | AVMED | OTHER |