MEDICARE: DORYAN MARTINEZ 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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	1-26-89697	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487351334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORYAN MARTINEZ PINO

Provider Business Mailing Address
First Line	:	117 NE SAGAMORE TER # 1
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-1287
Country	:	US
Telephone Number	:	786-259-5333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1887 SE PORT ST LUCIE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5530
Country	:	US
Telephone Number	:	786-259-5333
Fax Number	:

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

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	05/06/2026

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Directions to “ DORYAN MARTINEZ PINO ” Practice Location

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