Healthcare Provider Details

I. General information

NPI: 1164072781
Provider Name (Legal Business Name): BRYANNA E PINO M.A., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S HAZEL ST
VAN METER IA
50261-9713
US

IV. Provider business mailing address

407 S HAZEL ST
VAN METER IA
50261-9713
US

V. Phone/Fax

Practice location:
  • Phone: 505-730-9738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: