TITO DENIX PENA GUZMAN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

NOT RENEWED

Business

First Name

TITO

Middle

DENIX

Last Name

PENA GUZMAN

Business Name

TITO DENIX PENA GUZMAN

Original Issue Date

02/26/2007

Effective Date

06/20/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60660

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017