JAYDIENNE PAULISA C FONTEJON DPM Podiatrist License verification

Business Entity

INACTIVE

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****86

License Status

INACTIVE

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

07/18/2024

Expiration Date

01/31/2025

City

BENSENVILLE

State

Zip

60106

County

DUPAGE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/23/2025