MIRKO VILLANUEVA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****47

License Status

ACTIVE

Business

Title

First Name

MIRKO

Last Name

VILLANUEVA

Business Name

MIRKO VILLANUEVA MD

Original Issue Date

11/01/2022

Effective Date

06/29/2023

Expiration Date

07/31/2026

City

TACOMA

State

Zip

98402

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/29/2023