HEIDELENE E DE LA ROSA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

NOT RENEWED

Business

First Name

HEIDELENE

Middle

Last Name

DE LA ROSA

Business Name

HEIDELENE E DE LA ROSA

Original Issue Date

01/20/1999

Effective Date

01/20/1999

Expiration Date

07/31/2008

City

FLORA

State

Zip

62839

County

CLAY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008