IMELDA D DE VILLA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****39

License Status

ACTIVE

Business

Title

First Name

IMELDA

Middle

Last Name

DE VILLA

Business Name

IMELDA D DE VILLA MD

Original Issue Date

10/01/2022

Effective Date

08/10/2023

Expiration Date

07/31/2026

City

UNIVERSITY PLACE

State

Zip

98467

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/10/2023