Healthcare Provider Details

I. General information

NPI: 1629986989
Provider Name (Legal Business Name): MELISSA M HYBARGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3699 HOLLY AVE
BALDWIN PARK CA
91706-5327
US

IV. Provider business mailing address

7338 ALTA VIS
LA VERNE CA
91750-1115
US

V. Phone/Fax

Practice location:
  • Phone: 626-962-3311
  • Fax:
Mailing address:
  • Phone: 626-625-0391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: