Organization
ILLUMINATE MEDICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORIS COUNCIL (CEO)
(409) 356-9778
Entity
Organization
Contact information
Practice address
7891 SLATE CREEK RD, CORONA, CA 92880-8544
(409) 356-9778
Mailing address
7891 SLATE CREEK RD, CORONA, CA 92880-8544
(409) 356-9778
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/19/2024
Last updated
02/19/2024
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