IVAN SOUTH FUCILLA MD - Medical Doctor License in California | # 036035854

IVAN SOUTH FUCILLA MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036035854

License Status

NOT RENEWED

Business

N

First Name

IVAN SOUTH

Last Name

FUCILLA

Suffix

MD

Business Name

IVAN SOUTH FUCILLA MD

Original Issue Date

06/09/1959

Effective Date

06/09/1959

Expiration Date

07/31/1984

State

CA

Ever Disciplined

N

LastModifiedDate

09/20/2006