Healthcare Provider Details

I. General information

NPI: 1861837148
Provider Name (Legal Business Name): MELISSA ANN MUELLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 POST ST STE 1701
SAN FRANCISCO CA
94102-1308
US

IV. Provider business mailing address

530 DIVISADERO ST. PMB 759
SAN FRANCISCO CA
94117-2213
US

V. Phone/Fax

Practice location:
  • Phone: 415-523-5235
  • Fax: 415-523-5235
Mailing address:
  • Phone: 415-523-5235
  • Fax: 415-523-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA135625
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number01083931A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: