Nicole Vienna, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

464 E Bonita Ave
Suite 11
San Dimas, CA 91773-3144

Phone

(626) 709-3494

NPI assigned

Oct 15, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Nicole Radford Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2019 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487894400000",
    "number": "1073702197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "464 E BONITA AVE",
            "address_2": "SUITE 11",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733144",
            "telephone_number": "626-709-3494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "464 E BONITA AVE",
            "address_2": "SUITE 11",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733144",
            "telephone_number": "626-709-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIENNA",
        "first_name": "NICOLE",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-15",
        "last_updated": "2017-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "RADFORD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Psychologist in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.