CICELY LATRICE MORENO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125069704

License Status

CANCELLED

Business

First Name

CICELY

Middle

LATRICE

Last Name

MORENO

Business Name

CICELY LATRICE MORENO

Original Issue Date

08/01/2016

Effective Date

08/01/2016

Expiration Date

07/31/2019

City

GARY

State

Zip

46404

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

08/01/2016