Provider Demographics
NPI:1467461228
Name:PROGRESSIVE RADIOLOGY SERVICES
Entity Type:Organization
Organization Name:PROGRESSIVE RADIOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:MELITA
Authorized Official - Last Name:MOELLEKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-931-6322
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:415-931-6322
Mailing Address - Fax:
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:415-321-4674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0524112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty