MARISELA DOMINGUEZ Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****31

License Status

NOT RENEWED

Business

First Name

MARISELA

Last Name

DOMINGUEZ

Business Name

MARISELA DOMINGUEZ

Original Issue Date

07/24/1995

Effective Date

06/10/2008

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011