MEDICARE: CECILIA HOLISTIC & WELLNESS FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1629870324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CECILIA HOLISTIC & WELLNESS FOUNDATION

Provider Business Mailing Address
First Line	:	10950 CHURCH ST APT 2522
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-8084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10950 CHURCH ST APT 2522
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-8084
Country	:	US
Telephone Number	:	840-256-9307
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JAZSMINE LOVELACE
Credential	:
Telephone Number	:	840-256-9307

Provider Enumeration Date	:	03/25/2025
Last Update Date	:	03/25/2025

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Directions to “CECILIA HOLISTIC & WELLNESS FOUNDATION ” Practice Location

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