Provider Demographics
NPI:1376748673
Name:HOLLINGSWORTH, JEFFREY JACOB (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JACOB
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 14TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2554
Mailing Address - Country:US
Mailing Address - Phone:858-261-4622
Mailing Address - Fax:858-722-1990
Practice Address - Street 1:317 14TH ST STE A
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2554
Practice Address - Country:US
Practice Address - Phone:858-261-4622
Practice Address - Fax:858-722-1990
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP04082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry