Provider Demographics
NPI:1114976578
Name:MOELLEKEN, SONJA CLAR MELITA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:CLAR MELITA
Last Name:MOELLEKEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 FRANCISCO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-1127
Mailing Address - Country:US
Mailing Address - Phone:415-533-6322
Mailing Address - Fax:415-533-6322
Practice Address - Street 1:325 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-3601
Practice Address - Country:US
Practice Address - Phone:415-533-6322
Practice Address - Fax:415-533-6322
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA524112085R0202X
CAA3847231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A524110OtherBC/BS OF CA
CA1114976578Medicaid
CACB230889Medicare PIN
CA1114976578Medicaid
CACA156755Medicare PIN