PATRINA OPAL AGOSTA Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130001416

License Status

EXPIRED

Business

First Name

PATRINA

Middle

OPAL

Last Name

AGOSTA

Business Name

PATRINA OPAL AGOSTA

Original Issue Date

11/01/2021

Effective Date

11/01/2021

Expiration Date

11/30/2021

City

CHICAGO

State

Zip

60637

Specialty/Qualifier

Female Pelvic Med Reconstructive Surg

Ever Disciplined

LastModifiedDate

10/11/2022