ANGELITA V FONTANILLA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****78

License Status

NOT RENEWED

Business

Title

First Name

ANGELITA

Middle

Last Name

FONTANILLA

Business Name

ANGELITA V FONTANILLA MD

Original Issue Date

08/18/2010

Effective Date

07/08/2011

Expiration Date

07/31/2014

City

WATSEKA

State

Zip

60970

County

IROQUOIS

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

11/17/2014