Provider Demographics
NPI:1104365873
Name:NELKIN, VIANNAE CARMONA (BCABA)
Entity Type:Individual
Prefix:
First Name:VIANNAE
Middle Name:CARMONA
Last Name:NELKIN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:VIANNAE
Other - Middle Name:
Other - Last Name:CARMONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
Mailing Address - Street 1:5350 MACHADO LN
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-8800
Mailing Address - Country:US
Mailing Address - Phone:310-737-9393
Mailing Address - Fax:310-881-0069
Practice Address - Street 1:5350 MACHADO LN
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-8800
Practice Address - Country:US
Practice Address - Phone:310-737-9393
Practice Address - Fax:310-881-0069
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-14-6039106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst