Illuminate Medical Inc

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

ILLUMINATE MEDICAL INC

Practice address

7891 Slate Creek Rd
Corona, CA 92880-8544

Phone

(409) 356-9778

NPI assigned

Feb 19, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Doris Council

Title

Ceo

Phone

(409) 356-9778

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708300800000",
    "number": "1043075112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7891 SLATE CREEK RD",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928808544",
            "telephone_number": "409-356-9778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7891 SLATE CREEK RD",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928808544",
            "telephone_number": "409-356-9778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATE MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-19",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A",
        "authorized_official_last_name": "COUNCIL",
        "authorized_official_first_name": "DORIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "409-356-9778"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Corona, CA
• Providers in Corona, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.