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General NPI Number Information
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NPI Number | 1346124286
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Entity Type | Individual
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Provider Name | ILORIA VICTORIA PHOENIX LOPEZ M.A.
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Gender | Female
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 1801 HICKMAN RD
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City | DES MOINES
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State | IA
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Zip | 50314-1548
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Country | US
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Telephone | 515-282-5695
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 23RD ST
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City | DES MOINES
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State | IA
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Zip | 50310-6022
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Country | US
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Telephone | 336-987-6782
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0084
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License Number State | IA
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