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General NPI Number Information
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NPI Number | 1619054962
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Entity Type | Organization
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Legal Business Name | INCONTINENCE AND PELVIC SUPPORT INSTITUTE
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 26800 CROWN VALLEY PKWY STE 475
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City | MISSION VIEJO
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State | CA
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Zip | 92691-8027
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Country | US
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Telephone | 888-827-3286
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Fax |
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Provider Business Mailing Address
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Address Line | 28432 VIA MAMBRINO
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3346
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Country | US
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Telephone | 949-584-7505
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | LISA ANDRADE
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Credential |
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Telephone | 949-365-8845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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