Healthcare Provider Details

I. General information

NPI: 1114976578
Provider Name (Legal Business Name): SONJA CLAR MELITA MOELLEKEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 SACRAMENTO ST
SAN FRANCISCO CA
94111-3601
US

IV. Provider business mailing address

1020 FRANCISCO ST
SAN FRANCISCO CA
94109-1127
US

V. Phone/Fax

Practice location:
  • Phone: 415-533-6322
  • Fax: 415-533-6322
Mailing address:
  • Phone: 415-533-6322
  • Fax: 415-533-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA52411
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA3847231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: