CICELY LATRICE MORENO - Medical Doctor License in Indiana | # 125069704

CICELY LATRICE MORENO

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125069704

License Status

CANCELLED

Business

N

First Name

CICELY

Middle

LATRICE

Last Name

MORENO

Business Name

CICELY LATRICE MORENO

Original Issue Date

08/01/2016

Effective Date

08/01/2016

Expiration Date

07/31/2019

State

IN

Specialty/Qualifier

Psychiatry

Ever Disciplined

N

LastModifiedDate

08/01/2016