MEDICARE: IP HEALTHCARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1073408266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IP HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	2515 SANTA CLARA AVE STE 104
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4667
Country	:	US
Telephone Number	:	510-415-2743
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 SANTA CLARA AVE STE 104
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4667
Country	:	US
Telephone Number	:	510-415-2743
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IRENEE PAULE
Credential	:
Telephone Number	:	510-415-2743

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	11/21/2025

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