LESLIE DALAZA MATTSON MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057659

License Status

CANCELLED

Business

Title

First Name

LESLIE

Middle

DALAZA

Last Name

MATTSON

Business Name

LESLIE DALAZA MATTSON MD

Original Issue Date

06/22/2010

Effective Date

06/22/2010

Expiration Date

06/21/2013

City

BLOOMINGDALE

State

Zip

60108

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/07/2010