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
—
—
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
122300000X
Dentist
—
—
163W00000X
Registered Nurse
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
261QC1500X
Community Health Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
07/21/2020
Last updated
06/09/2025
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