Provider Demographics
NPI:1164174512
Name:PINO MARTIN, ANA FLAVIA (RBT)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:FLAVIA
Last Name:PINO MARTIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13557 SW 64TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5012
Mailing Address - Country:US
Mailing Address - Phone:786-307-3626
Mailing Address - Fax:
Practice Address - Street 1:815 NW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2018
Practice Address - Country:US
Practice Address - Phone:786-307-3626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-196937106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician