Patricia A Wallace (NPI# 1629162995, PAC ID# 9739128489) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is OBSTETRICS/GYNECOLOGY.
| Nation Provider ID (NPI) | 1629162995 |
| PAC ID by PECOS | 9739128489 |
| Professional Enrollment ID | I20050502000824 |
| Full Name | Patricia A Wallace |
| Organization Legal Name | INCONTINENCE AND PELVIC SUPPORT INSTITUTE |
| Address |
26732 Crown Vly Pkwy Suite 327 Mission Viejo CA 92691-6374 |
| Phone Number | 7143644400 |
| Gender | F |
| Credential | MD |
| Medical School | UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON |
| Graduation Year | 1997 |
| Primary Specialty | OBSTETRICS/GYNECOLOGY |
| Group Practice PAC ID | 5991748154 |
| Number of Group Practice Members | 4 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 050567 | MISSION HOSPITAL REGIONAL MED CENTER |
| 050224 | HOAG MEMORIAL HOSPITAL PRESBYTERIAN |
| Address | Phone | Organization |
|---|---|---|
| 26732 Crown Vly Pkwy, Suite 327, Mission Viejo, CA 92691-6374 | 7143644400 | INCONTINENCE AND PELVIC SUPPORT INSTITUTE |
| Organization Legal Name | INCONTINENCE AND PELVIC SUPPORT INSTITUTE |
| Physicians | 4 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Theodore Val Benderev | Urology | Incontinence and Pelvic Support Institute | 26732 Crown Vly Pkwy, Suite 327, Mission Viejo, CA 92691-6374 |
| Kim Kanaly | Obstetrics/gynecology | Incontinence and Pelvic Support Institute | 26732 Crown Vly Pkwy, Suite 327, Mission Viejo, CA 92691-6374 |
| Christine Horton | Undefined Physician Type (specify) | Incontinence and Pelvic Support Institute | 26732 Crown Vly Pkwy, Suite 327, Mission Viejo, CA 92691-6374 |
| Street Address |
26732 CROWN VLY PKWY SUITE 327 |
| City | MISSION VIEJO |
| State | CA |
| Zip | 92691-6374 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Theodore Val Benderev | Urology | Incontinence and Pelvic Support Institute | 26732 Crown Vly Pkwy, Suite 327, Mission Viejo, CA 92691-6374 |
| Kim Kanaly | Obstetrics/gynecology | Incontinence and Pelvic Support Institute | 26732 Crown Vly Pkwy, Suite 327, Mission Viejo, CA 92691-6374 |
| Christine Horton | Undefined Physician Type (specify) | Incontinence and Pelvic Support Institute | 26732 Crown Vly Pkwy, Suite 327, Mission Viejo, CA 92691-6374 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Howard L Kim | Neurology | Neuralview Medical Group PC | 27246 Villanueva, Mission Viejo, CA 92691-2139 |
| Kim C Till | Clinical Social Worker | County of Orange | 23228 Madero, Mission Viejo, CA 92691-2706 |
| Abigail Mecham | Clinical Social Worker | County of Orange | 23228 Madero, Mission Viejo, CA 92691-2706 |
| Daniel Kanoa Bever | Physical Therapy | Southland Physical Therapy Inc | 25565 Jeronimo Rd, Mission Viejo, CA 92691-2707 |
| Marina A Ball | Dermatology | Southern California Permanente Medical Group | 23781 Maquina, Mission Viejo, CA 92691-2716 |
| Kevin R Yuhan | Ophthalmology | Southern California Permanente Medical Group | 23781 Maquina, Mission Viejo, CA 92691-2716 |
| My-lan Le-nguyen | Family Medicine | Southern California Permanente Medical Group | 23781 Maquina, Mission Viejo, CA 92691-2716 |
| Keith J Pince | Ophthalmology | Southern California Permanente Medical Group | 23781 Maquina, Mission Viejo, CA 92691-2716 |
| Pauline Chang Uehara | Optometry | Southern California Permanente Medical Group | 23781 Maquina, Mission Viejo, CA 92691-2716 |
| Michael Kim | Family Medicine | Southern California Permanente Medical Group | 23781 Maquina, Mission Viejo, CA 92691-2716 |
| Find all physicians in zip 92691 | |||
| City | MISSION VIEJO |
| Zip Code | 92691 |
| Specialty | OBSTETRICS/GYNECOLOGY |
| City + Specialty | MISSION VIEJO + OBSTETRICS/GYNECOLOGY |
Please comment or provide details below to improve the information on Patricia A Wallace.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.