ANGEL PEMAYUN ANAK-AGUNG-GEDE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085007079

License Status

NOT RENEWED

Business

First Name

ANGEL

Middle

PEMAYUN

Last Name

ANAK-AGUNG-GEDE

Business Name

ANGEL PEMAYUN ANAK-AGUNG-GEDE

Original Issue Date

06/17/2019

Effective Date

01/21/2020

Expiration Date

03/01/2022

City

SAN DIEGO

State

Zip

92121

Ever Disciplined

LastModifiedDate

07/27/2022