MEDICARE: RIAN MARTINEZ

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	1-23-67317	AZ

General Provider Information

NPI Number	:	1598353310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIAN MARTINEZ

Provider Business Mailing Address
First Line	:	1347 N ALMA SCHOOL RD STE 220
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5932
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1347 N ALMA SCHOOL RD STE 220
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5932
Country	:	US
Telephone Number	:	888-754-0398
Fax Number	:

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

Provider Enumeration Date	:	01/07/2021
Last Update Date	:	08/10/2023

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Directions to “ RIAN MARTINEZ ” Practice Location

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