BERNADETA LEEGAN WIBISONO MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125055427

License Status

CANCELLED

Business

Title

First Name

BERNADETA

Middle

LEEGAN

Last Name

WIBISONO

Business Name

BERNADETA LEEGAN WIBISONO MD

Original Issue Date

07/01/2008

Effective Date

07/01/2008

Expiration Date

06/30/2011

City

MARTINEZ

State

Zip

94553

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

05/01/2008