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 1:28432 VIA MAMBRINO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3346
Mailing Address - Country:US
Mailing Address - Phone:949-584-7505
Mailing Address - Fax:
Practice Address - Street 1:26800 CROWN VALLEY PKWY STE 475
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8027
Practice Address - Country:US
Practice Address - Phone:888-827-3286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty