Healthcare Provider Details

I. General information

NPI: 1013695089
Provider Name (Legal Business Name): PAIGE IRVINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 ESTUDILLO AVE
SAN LEANDRO CA
94577-4611
US

IV. Provider business mailing address

PO BOX 22555
OAKLAND CA
94609-5155
US

V. Phone/Fax

Practice location:
  • Phone: 510-657-7409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number279436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: