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General NPI Number Information
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NPI Number | 1912134552
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Entity Type | Individual
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Provider Name | CHRISTIAN MOLSTROM M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 1310 EL CAMINO REAL STE J
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City | SAN BRUNO
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State | CA
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Zip | 94066-1305
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Country | US
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Telephone | 650-270-2395
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Fax | 650-270-2397
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Provider Business Mailing Address
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Address Line | 2945 NE 23RD AVE
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City | PORTLAND
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State | OR
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Zip | 97212-3452
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Country | US
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Telephone | 503-757-5779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD157220
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | C170858
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License Number State | CA
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