NATHALIE MANTILLA FARFAN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****19

License Status

ACTIVE

Business

First Name

NATHALIE

Last Name

MANTILLA FARFAN

Suffix

Business Name

NATHALIE MANTILLA FARFAN MD

Original Issue Date

05/31/2016

Effective Date

05/10/2023

Expiration Date

07/31/2026

City

RIVER FOREST

State

Zip

60305

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/10/2023