BERNADETA LEEGAN WIBISONO MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****14

License Status

ACTIVE

Business

Title

First Name

BERNADETA

Middle

LEEGAN

Last Name

WIBISONO

Business Name

BERNADETA LEEGAN WIBISONO MD

Original Issue Date

04/19/2011

Effective Date

05/27/2023

Expiration Date

07/31/2026

City

MARTINEZ

State

Zip

94553

County

WILL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/27/2023