LOLITA TINA ONTIVEROS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****25

License Status

NOT RENEWED

Business

Title

First Name

LOLITA

Middle

TINA

Last Name

ONTIVEROS

Business Name

LOLITA TINA ONTIVEROS MD

Original Issue Date

08/23/2017

Effective Date

08/23/2017

Expiration Date

09/30/2020

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021