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General NPI Number Information
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NPI Number | 1205444742
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Entity Type | Organization
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Legal Business Name | CLARKE LEW MEDICAL CORP
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 3535 W COMMONWEALTH AVE
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City | FULLERTON
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State | CA
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Zip | 92833-2821
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Country | US
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Telephone | 949-273-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 W COMMONWEALTH AVE
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City | FULLERTON
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State | CA
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Zip | 92833-2821
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Country | US
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Telephone | 714-402-2766
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Fax |
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Authorized Official
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Title or Position | BILLING CONSULTANT
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Name | NICOLE ST. CLAIRE
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Credential |
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Telephone | 949-633-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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