MEDICARE: CORNELIA HOLMES M.D.

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	207Q00000X	Family Medicine Physician	A133878	CA

General Provider Information

NPI Number	:	1679961387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORNELIA HOLMES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	12488 CENTRAL AVE STE B
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-2625
Country	:	US
Telephone Number	:	909-613-0100
Fax Number	:	909-613-0600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2015
Last Update Date	:	11/19/2025

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