IVAN SOUTH FUCILLA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036035854

License Status

NOT RENEWED

Business

First Name

IVAN SOUTH

Last Name

FUCILLA

Suffix

Business Name

IVAN SOUTH FUCILLA MD

Original Issue Date

06/09/1959

Effective Date

06/09/1959

Expiration Date

07/31/1984

City

LOS ALTOS

State

Zip

94022

County

CALIFORNIA

Ever Disciplined

LastModifiedDate

09/20/2006