NATHALIE MANTILLA FARFAN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058482

License Status

CANCELLED

Business

First Name

NATHALIE

Last Name

MANTILLA FARFAN

Suffix

Business Name

NATHALIE MANTILLA FARFAN MD

Original Issue Date

07/14/2014

Effective Date

07/14/2014

Expiration Date

07/13/2016

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

05/27/2014