Healthcare Provider Details

I. General information

NPI: 1487351334
Provider Name (Legal Business Name): DORYAN MARTINEZ PINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 SE PORT ST LUCIE BLVD
PORT SAINT LUCIE FL
34952-5530
US

IV. Provider business mailing address

117 NE SAGAMORE TER # 1
PORT SAINT LUCIE FL
34983-1287
US

V. Phone/Fax

Practice location:
  • Phone: 786-259-5333
  • Fax:
Mailing address:
  • Phone: 786-259-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89697
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: