| Illumination Foundation Medical Group | |
|
3535 W Commonwealth Ave Fullerton CA 92833-2821 | |
| (949) 273-0555 | |
| Not Available |
| Full Name | Illumination Foundation Medical Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 3535 W Commonwealth Ave, Fullerton, California |
| Authorized Official Name and Position | Erika Lynne Silver (MEDICAL GROUP LIAISON) |
| Authorized Official Contact | 9492730555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Illumination Foundation Medical Group 1091 N Batavia St Orange CA 92867-5548 Ph: (949) 273-0555 | Illumination Foundation Medical Group 3535 W Commonwealth Ave Fullerton CA 92833-2821 Ph: (949) 273-0555 |
| NPI Number | 1205444742 |
|---|---|
| Provider Enumeration Date | 07/21/2020 |
| Last Update Date | 01/27/2021 |
| Certification Date | 01/27/2021 |
| Medicare PECOS PAC ID | 6507279676 |
|---|---|
| Medicare Enrollment ID | O20210108002376 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205444742 | NPI | - | NPPES |
| Provider Name | Clarke R Lew |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194768077 PECOS PAC ID: 6901864719 Enrollment ID: I20041227000736 |
| Provider Name | Ogbonna Iwuamadi Olelewe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043751886 PECOS PAC ID: 4284908906 Enrollment ID: I20170919003785 |
| Provider Name | Doan Q Nguyen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336503838 PECOS PAC ID: 0143584599 Enrollment ID: I20191002002125 |
| Provider Name | Monika Kumari Badyal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053681932 PECOS PAC ID: 0244640167 Enrollment ID: I20201104002870 |
| Provider Name | David J Han |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134633845 PECOS PAC ID: 6608281316 Enrollment ID: I20210210001615 |
| Provider Name | Ivy Tuason |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174976559 PECOS PAC ID: 8224441399 Enrollment ID: I20210305002159 |
| Provider Name | Tina M Mardirossian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598108375 PECOS PAC ID: 6406263185 Enrollment ID: I20210324002449 |
| Provider Name | Kensie L Hoag |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265966576 PECOS PAC ID: 0446667984 Enrollment ID: I20210329001057 |
| Provider Name | Ivy Y Chua |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053568402 PECOS PAC ID: 8729357330 Enrollment ID: I20210604002404 |
| Provider Name | Perlee C Tobias |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508450966 PECOS PAC ID: 7315340247 Enrollment ID: I20210729000878 |
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Orange County Center For Psychotherapy And Counseling Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 213 N Pomona Ave, Fullerton, CA 92832 Phone: 714-447-8011 Fax: 714-871-2203 | |
Sunny Hills Behavioral Health, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 111 W Bastanchury Rd, Suite 1a, Fullerton, CA 92835 Phone: 714-773-4111 Fax: 714-773-4222 | |
Fullerton Neuropsychological Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 385 Imperial Hwy, Fullerton, CA 92835 Phone: 714-681-9070 Fax: 714-773-4788 |