KETAMINE FOR LIFE, INC. (NPI# 1972046050) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972046050 |
| Entity Type | Organization |
| Organization Name | KETAMINE FOR LIFE, INC. |
| Other Organization Name | PACIFIC PSYCHIATRY AND ANESTHESIA ASSOCIATES |
| Practice Address |
317 14th St Ste A Del Mar CA 92014-2554 |
| Practice Telephone | 8582614622 |
| Practice Fax Number | 8587241990 |
| Mailing Telephone | 8582614622 |
| Mailing Fax Number | 8587241990 |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | DR. JEFFREY JACOB HOLLINGSWORTH (PRESIDENT) |
| Authorized Official Telephone | 8582614622 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
20A13243 | CA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Pacific Psychiatry And Anesthesia Associates | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1151 Dove St Ste 115, Newport Beach, CA 926602805 | 8582614622 | 8587241990 |
| Street Address |
317 14TH ST STE A |
| City | DEL MAR |
| State | CA |
| Zip Code | 92014-2554 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376748673 | Jeffrey Jacob Hollingsworth | Psychiatry & Neurology | 317 14th St Ste A, Del Mar, CA 92014-2554 | 2007-06-18 |
| 1952810251 | Earl Andrew B. De Guzman Md, Apc. | Psychiatry & Neurology | 317 14th St Ste A, Del Mar, CA 92014-2554 | 2017-09-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245751924 | Stanisai Dental Corporation | Dentist | 2710 Via De La Valle, Suite B250, Del Mar, CA 92014 | 2017-07-03 |
| 1750757886 | Darena Ann Bailey | Psychologist | 13778 Ruette Le Parc, Suite E, Del Mar, CA 92014 | 2015-08-12 |
| 1063754885 | James Anthony Bosch | Marriage & Family Therapist | 2002 Jimmy Durante Blvd Suite 124, Del Mar, CA 92014 | 2013-03-19 |
| 1255682167 | Allcare Behavioral Health | Community/Behavioral Health | 3790 Via Da La Valle, Suite 108e, Del Mar, CA 92014 | 2012-10-02 |
| 1952693467 | William Talbot Bowen | Emergency Medicine | 13734 Boquita Dr., Del Mar, CA 92014 | 2011-05-03 |
| 1821239567 | Kathyrn Engel | Social Worker | 13352 Caminito Carmel, Del Mar, CA 92014 | 2009-03-10 |
| 1356500839 | Hsin-ti S Chang | Dentist | 13760 Portofino Dr Apt A, Del Mar, CA 92014 | 2008-06-09 |
| 1952523177 | Ron Barry Dmd Inc. | Dentist | 13983 Mango Drive, Suite 202, Del Mar, CA 92014 | 2007-05-03 |
| 1225182769 | Kathleen Ann Larson | Social Worker | 1337 Camino Del Mar Ste B, Del Mar, CA 92014 | 2007-01-22 |
| 1144388554 | Charlotte Denise Scott | Chiropractor | 2636 Flower Hill Drive, Del Mar, CA 92014 | 2006-12-05 |
| Find all providers in zip 92014 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487001673 | Jorge A Zapatel, Md Apmc | Psychiatry & Neurology | 1011 Reliance Way, Del Mar, CA 92014-3922 | 2016-05-18 |
| 1316193493 | E. Clark Allen, M.d. Professional Corporation | Psychiatry & Neurology | 2424 Carmel Valley Rd, Del Mar, CA 92014-3802 | 2008-08-08 |
| 1376748673 | Jeffrey Jacob Hollingsworth | Psychiatry & Neurology | 317 14th St Ste A, Del Mar, CA 92014-2554 | 2007-06-18 |
| 1427252212 | Robert E Bloomgarden | Psychiatry & Neurology | 13465 Mango Dr, Del Mar, CA 92014-3536 | 2007-06-13 |
| 1134287352 | Elizabeth Ruth Hudler | Psychiatry & Neurology | 1125 Camino Del Mar Ste F, Del Mar, CA 92014-2645 | 2006-12-04 |
| 1932274891 | Carolyn Adele Josepho | Psychiatry & Neurology | 240 Ninth St, Del Mar, CA 92014 | 2006-11-22 |
| 1083789119 | Del Mar Psychiatric Center | Psychiatry & Neurology | 1343 Stratford Court, Del Mar Psychiatric Center, Del Mar, CA 92014 | 2006-11-22 |
| 1740360924 | Kim A. Gutner | Psychiatry & Neurology | 240 9th St, Del Mar, CA 92014-2717 | 2006-10-16 |
| 1881781334 | Edward Clark Allen | Psychiatry & Neurology | 2190 Carmel Valley Rd, B, Del Mar, CA 92014-3772 | 2006-10-06 |
| 1376517664 | Ann O Massion | Psychiatry & Neurology | 12835 Pointe Del Mar Way, Suite One, Del Mar, CA 92014-3846 | 2006-02-14 |
| Find all providers in DEL MAR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.