Provider Demographics
NPI:1336224237
Name:MOLLER, LENNART (MD)
Entity Type:Individual
Prefix:
First Name:LENNART
Middle Name:
Last Name:MOLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 STEINER ST
Mailing Address - Street 2:HENRY OHLHOFF RECOVERY PROGRAMS
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2509
Mailing Address - Country:US
Mailing Address - Phone:415-845-2727
Mailing Address - Fax:
Practice Address - Street 1:601 STEINER ST
Practice Address - Street 2:HENRY OHLHOFF RECOVERY PROGRAMS
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2509
Practice Address - Country:US
Practice Address - Phone:415-845-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG836502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G836500Medicaid
CA00G836500Medicaid
CA00G836500Medicare ID - Type Unspecified