Healthcare Provider Details

I. General information

NPI: 1639435613
Provider Name (Legal Business Name): KATERYNA RYBKINA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

5036 ALHAMA DR
WOODLAND HILLS CA
91364-3231
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-7860
  • Fax:
Mailing address:
  • Phone: 818-825-8384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number533323
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number17703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: