Provider Demographics
NPI:1710285697
Name:CHARLES E HOLLINGSWORTH MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHARLES E HOLLINGSWORTH MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHIATRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-454-1850
Mailing Address - Street 1:7825 FAY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4270
Mailing Address - Country:US
Mailing Address - Phone:858-454-1850
Mailing Address - Fax:858-454-1859
Practice Address - Street 1:7825 FAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4270
Practice Address - Country:US
Practice Address - Phone:858-454-1850
Practice Address - Fax:858-454-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4516428Medicare UPIN