MARIO PEREZ (Credential# 148462) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is April 10, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
MARIO PEREZ is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0010448. The credential type is controlled substance registration for practitioner. The effective date is April 10, 2019. The expiration date is February 28, 2021. The business address is 5085 Broughton St, Roswell, GA 30075-2598. The current status is active.
| Licensee Name | MARIO PEREZ |
| Credential ID | 148462 |
| Credential Number | CSP.0010448 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
5085 Broughton St Roswell GA 30075-2598 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1999-03-01 |
| Effective Date | 2019-04-10 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-04-11 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 541522 | 1.015531 | Physician/Surgeon | 1972-04-27 | 2019-01-01 - 2019-12-31 | INACTIVE |
| Street Address | 5085 BROUGHTON ST |
| City | ROSWELL |
| State | GA |
| Zip Code | 30075-2598 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Selena Kimble | 2817 Hemingway Lane, Roswell, GA 30075 | Registered Nurse | ~ |
| Sharon Elaine Grove | 315 Chickering Lake Ct, Roswell, GA 30075 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Sara E Callahan | 275 Spring Creek Road, Roswell, GA 30075 | Professional Counselor | 2020-05-01 ~ 2021-04-30 |
| Michael N Shewchuk | 4493 Old Mabry Pl Ne, Roswell, GA 30075 | Professional Engineer | 2020-02-11 ~ 2021-01-31 |
| David J Rainone | 1008 Taimen Dr, Roswell, GA 30075 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Harold D Chandler | 3307 Lantern Coach Lane Ne, Roswell, GA 30075 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Matthew G Derocher | 8035 Cedar Cove, Roswell, GA 30075 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Eric M Wolf | 2853 Tynewick Dr., Roswell, GA 30075 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Matthew E Watkins | 3876 Dundee Drive Ne, Roswell, GA 30075 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Kathleen M Boyle | 3701 Mabry Road Ne, Roswell, GA 30075 | Licensed Practical Nurse | 2019-12-01 ~ 2020-11-30 |
| Find all Licenses in zip 30075 | |||
| City | ROSWELL |
| Zip Code | 30075 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + ROSWELL |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Mario F Perez Md | Po Box 266, Durham, CT 06422 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Mario Mutic | 36 Jefferson Rd, Scarsdale, NY 10583-6436 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Mario Amleto Md | 415 Killingworth Rd, Higganum, CT 06441 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Mario J Robles Md | 25 Newell Rd, Bristol, CT 06010 | Controlled Substance Registration for Practitioner | 2002-03-01 ~ 2003-02-28 |
| Mario A Grosso | 84 Round Hill Rd Apt D, Northampton, MA 01060-2281 | Controlled Substance Registration for Practitioner | 2013-05-17 ~ 2015-02-28 |
| Mario Q Ricci | 410 Saybrook Road, Middletown, CT 06457 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Mario J D'angelo Od | 373 Main Street, Torrington, CT 06790 | Controlled Substance Registration for Practitioner | 2011-10-20 ~ 2013-02-28 |
| Mario E Ochoa Prieto | 64 Robbins St, Waterbury, CT 06708-2613 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Mario Sznol Md | 333 Cedar St Www222, New Haven, CT 06520 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Mario J Sculco | 195 Washington Street, Norwich, CT 06360 | Controlled Substance Registration for Practitioner | 2004-02-29 ~ 2005-02-28 |
Please comment or provide details below to improve the information on MARIO PEREZ.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).