XAVIER ERNESTO FONSECA FUENTES Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036153275

License Status

NOT RENEWED

Business

First Name

XAVIER

Middle

ERNESTO

Last Name

FONSECA FUENTES

Business Name

XAVIER ERNESTO FONSECA FUENTES

Original Issue Date

06/08/2020

Effective Date

06/08/2020

Expiration Date

07/31/2023

City

OAK LAWN

State

Zip

60453

County

COOK

Ever Disciplined

LastModifiedDate

11/30/2023