Provider Demographics
NPI:1720256605
Name:PROGRESSIVE RADIOLOGY SERVICES
Entity Type:Organization
Organization Name:PROGRESSIVE RADIOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOELLEKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-321-4682
Mailing Address - Street 1:1201 MARINA VILLAGE PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1087
Mailing Address - Country:US
Mailing Address - Phone:510-865-9670
Mailing Address - Fax:
Practice Address - Street 1:1860 EL CAMINO REAL
Practice Address - Street 2:SUITE 101
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3127
Practice Address - Country:US
Practice Address - Phone:510-865-9670
Practice Address - Fax:510-865-9680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVE RADIOLOGY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology