Healthcare Provider Details

I. General information

NPI: 1104365873
Provider Name (Legal Business Name): VIANNAE CARMONA NELKIN PSYD, BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIANNAE CARMONA BCABA

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 04/10/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S ROBERTSON BLVD STE B
LOS ANGELES CA
90035-1642
US

IV. Provider business mailing address

8549 WILSHIRE BLVD STE 1296
BEVERLY HILLS CA
90211-3104
US

V. Phone/Fax

Practice location:
  • Phone: 424-274-0507
  • Fax:
Mailing address:
  • Phone: 424-274-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-14-6039
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number35541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: