MA OLIVIA R SAN DIEGO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****21

License Status

NOT RENEWED

Business

Title

First Name

MA OLIVIA

Middle

Last Name

SAN DIEGO

Business Name

MA OLIVIA R SAN DIEGO MD

Original Issue Date

09/07/2012

Effective Date

08/07/2014

Expiration Date

07/31/2017

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017