Provider Demographics
NPI:1992720098
Name:HOLLINGSWORTH, CHARLES E (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7825 FAY AVENUE
Mailing Address - Street 2:SUITE 200
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 AVENUE
Practice Address - Street 2:SUITE 200
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0250842084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4516428Medicaid
CAA90917Medicare UPIN
CAA90917Medicare ID - Type Unspecified