JAYDIENNE PAULISA C FONTEJON DPM Podiatrist License verification

Business Entity

ACTIVE

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****85

License Status

ACTIVE

Business

Title

DPM

First Name

JAYDIENNE PAULISA

Middle

Last Name

FONTEJON

Business Name

JAYDIENNE PAULISA C FONTEJON DPM

Original Issue Date

07/18/2024

Effective Date

11/04/2024

Expiration Date

01/31/2027

City

LOMBARD

State

Zip

60148

County

DUPAGE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2024