Provider Demographics
NPI:1619054962
Name:INCONTINENCE AND PELVIC SUPPORT INSTITUTE
Entity Type:Organization
Organization Name:INCONTINENCE AND PELVIC SUPPORT INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-365-8845
Mailing Address - Street 1:26732 CROWN VALLEY PKWY STE 381
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-7303
Mailing Address - Country:US
Mailing Address - Phone:949-364-4400
Mailing Address - Fax:949-364-2829
Practice Address - Street 1:26732 CROWN VALLEY PKWY STE 381
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-7303
Practice Address - Country:US
Practice Address - Phone:949-364-4400
Practice Address - Fax:949-364-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty