TITO DENIX PENA GUZMAN Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048666

License Status

CANCELLED

Business

First Name

TITO

Middle

DENIX

Last Name

PENA GUZMAN

Business Name

TITO DENIX PENA GUZMAN

Original Issue Date

07/01/2004

Effective Date

07/01/2004

Expiration Date

06/30/2007

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006