Healthcare Provider Details

I. General information

NPI: 1659519098
Provider Name (Legal Business Name): SARA H RYKOFF M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11340 W OLYMPIC BLVD SUITE 255
LOS ANGELES CA
90064-1608
US

IV. Provider business mailing address

11340 W. OLYMPIC BLVD. SUITE 255
LOS ANGELES CA
90064
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-7876
  • Fax: 310-395-5024
Mailing address:
  • Phone: 310-478-7876
  • Fax: 310-395-5024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT22458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: