HAZEL DHATES DOMINGO Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****42

License Status

ACTIVE

Business

First Name

HAZEL

Middle

DHATES

Last Name

DOMINGO

Business Name

HAZEL DHATES DOMINGO

Original Issue Date

08/27/2019

Effective Date

02/27/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60611

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/27/2026