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NPI 1629870324

NPI 1629870324 : CECILIA HOLISTIC & WELLNESS FOUNDATION : RANCHO CUCAMONGA, CA

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General NPI Number Information
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    NPI Number           |    1629870324
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    Entity Type          |    Organization 
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    Legal Business Name  |    CECILIA HOLISTIC & WELLNESS FOUNDATION 
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Dates
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    Enumeration Date     |    03/25/2025
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    Last Update Date     |    03/25/2025
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Provider Practice Location Address
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    Address Line         |    10950 CHURCH ST APT 2522 
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    City                 |    RANCHO CUCAMONGA
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    State                |    CA
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    Zip                  |    91730-8084
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    Country              |    US
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    Telephone            |    840-256-9307
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    10950 CHURCH ST APT 2522 
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    City                 |    RANCHO CUCAMONGA
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    State                |    CA
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    Zip                  |    91730-8084
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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Authorized Official
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    Title or Position    |    CEO
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    Name                 |     JAZSMINE  LOVELACE 
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    Credential           |    
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    Telephone            |    840-256-9307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    172V00000X
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    Taxonomy Name        |    Community Health Worker
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    License Number       |    
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    License Number State |    
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