Healthcare Provider Details

I. General information

NPI: 1003795550
Provider Name (Legal Business Name): MARIYA RYBAKOVA M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 OVERLAND AVE
LOS ANGELES CA
90034-5521
US

IV. Provider business mailing address

5807 TOPANGA CANYON BLVD APT B106
WOODLAND HILLS CA
91367-4615
US

V. Phone/Fax

Practice location:
  • Phone: 310-839-5201
  • Fax:
Mailing address:
  • Phone: 818-620-1532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: