Provider Demographics
NPI:1659350361
Name:HOLLINGSWORTH, DOROTHY MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:MARIE
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:DOROTHY
Other - Middle Name:MARIE
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2655 CAMINO DEL RIO NORTH
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-260-6300
Mailing Address - Fax:858-373-2446
Practice Address - Street 1:2655 CAMINO DEL RIO NORTH
Practice Address - Street 2:SUITE 330
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-964-1140
Practice Address - Fax:858-373-2446
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16710363A00000X
CA16710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA16710CMedicare ID - Type Unspecified
P80221Medicare UPIN
CAP80221Medicare UPIN