XAVIER ERNESTO FONSECA FUENTES Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****57

License Status

NOT RENEWED

Business

First Name

XAVIER

Middle

ERNESTO

Last Name

FONSECA FUENTES

Business Name

XAVIER ERNESTO FONSECA FUENTES

Original Issue Date

07/08/2020

Effective Date

07/08/2020

Expiration Date

07/31/2023

City

OAK LAWN

State

Zip

60453

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023