Healthcare Provider Details

I. General information

NPI: 1710285697
Provider Name (Legal Business Name): CHARLES E HOLLINGSWORTH MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7825 FAY AVE STE 200
LA JOLLA CA
92037-4270
US

IV. Provider business mailing address

7825 FAY AVE STE 200
LA JOLLA CA
92037-4270
US

V. Phone/Fax

Practice location:
  • Phone: 858-454-1850
  • Fax: 858-454-1859
Mailing address:
  • Phone: 858-454-1850
  • Fax: 858-454-1859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES EDWARD HOLLINGSWORTH
Title or Position: PRESIDENT/PSYCHIATRIST
Credential: M.D.
Phone: 858-454-1850