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General NPI Number Information
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NPI Number | 1588034433
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Entity Type | Individual
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Provider Name | TARA VELLELLA BCBA
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Gender | Female
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Dates
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Enumeration Date | 10/05/2015
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 3645 CARDIFF AVE # 304
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City | LOS ANGELES
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State | CA
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Zip | 90034-7800
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Country | US
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Telephone | 310-821-0963
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Fax |
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Provider Business Mailing Address
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Address Line | 378 FOWLING ST
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7730
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Country | US
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Telephone | 651-285-2818
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-15-19978
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License Number State | CA
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