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Organization
CLARKE LEW MEDICAL CORP
Active
Organization
CLARKE LEW MEDICAL CORP
Active
Other names
Illumination Foundation Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE ST. CLAIRE (BILLING CONSULTANT)
(949) 633-5535
Entity
Organization
Contact information
Practice address
3535 W COMMONWEALTH AVE, FULLERTON, CA 92833-2821
(949) 273-0555
Mailing address
3535 W COMMONWEALTH AVE, FULLERTON, CA 92833-2821
(714) 402-2766
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
NULL
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
122300000X
Dentist
—
NULL
122300000X
Dentist
—
—
163W00000X
Registered Nurse
—
NULL
163W00000X
Registered Nurse
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
261QC1500X
Community Health Clinic/Center
Primary
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
07/21/2020
Last updated
06/09/2025
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