MIA SONIA SCHULTZ TANAKA DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058312

License Status

CANCELLED

Business

Title

First Name

MIA SONIA

Middle

SCHULTZ

Last Name

TANAKA

Business Name

MIA SONIA SCHULTZ TANAKA DO

Original Issue Date

07/01/2010

Effective Date

07/01/2010

Expiration Date

06/30/2013

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

05/05/2010