Provider Demographics
NPI:1548367527
Name:HOLLINGSWORTH, JOHN M (PAC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:HOLLINGSWORTH
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Gender:M
Credentials:PAC
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Mailing Address - Street 1:6386 ALVARADO CT
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4905
Mailing Address - Country:US
Mailing Address - Phone:619-286-6687
Mailing Address - Fax:619-286-6695
Practice Address - Street 1:6386 ALVARADO CT
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4905
Practice Address - Country:US
Practice Address - Phone:619-286-6687
Practice Address - Fax:619-286-6695
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA14372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant