LOLITA TINA ONTIVEROS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125064436

License Status

CANCELLED

Business

Title

First Name

LOLITA

Middle

TINA

Last Name

ONTIVEROS

Business Name

LOLITA TINA ONTIVEROS MD

Original Issue Date

07/01/2014

Effective Date

07/01/2014

Expiration Date

06/30/2017

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

05/08/2014