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General NPI Number Information
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NPI Number | 1740725639
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Entity Type | Organization
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Legal Business Name | VIVIAN INSUA-LOPEZ PSY D PSYCHOLOGIST INC
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Dates
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Enumeration Date | 12/30/2016
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 15455 SAN FERNANDO MISSON BLVD. #308
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City | MISSION HILLS
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State | CA
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Zip | 91345
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Country | US
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Telephone | 818-408-9284
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Fax | 818-847-7830
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Provider Business Mailing Address
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Address Line | 15455 SAN FERNANDO MISSION BLVD STE 300
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City | MISSION HILLS
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State | CA
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Zip | 91345-1353
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Country | US
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Telephone | 818-408-9284
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Fax | 818-847-7830
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Authorized Official
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Title or Position | PSYCHOLOGISTS
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Name | DR. VIVIAN BARBARA INSUA-LOPEZ
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Credential | PSY.D
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Telephone | 818-408-9284
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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 | PSY26404
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License Number State | CA
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