MEDICARE: LUIS PINO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	103K00000X	Behavior Analyst		FL

General Provider Information

NPI Number	:	1376082602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS PINO

Provider Business Mailing Address
First Line	:	401 NW 59TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3137
Country	:	US
Telephone Number	:	305-546-7653
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 NW 59TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3137
Country	:	US
Telephone Number	:	305-546-7653
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2017
Last Update Date	:	02/20/2017

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Directions to “ LUIS PINO ” Practice Location

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