MARTHA L BALLESTAS-REVOLLO (Credential# 1298013) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is October 13, 2015. The license expiration date date is August 31, 2016. The license status is INACTIVE.
MARTHA L BALLESTAS-REVOLLO is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.054689. The credential type is physician/surgeon. The effective date is October 13, 2015. The expiration date is August 31, 2016. The business address is 10 Avalon Dr Unit 3323, Milford, CT 06460-8577. The current status is inactive.
| Licensee Name | MARTHA L BALLESTAS-REVOLLO |
| Credential ID | 1298013 |
| Credential Number | 1.054689 |
| Credential Type | Physician/Surgeon |
| Business Address |
10 Avalon Dr Unit 3323 Milford CT 06460-8577 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2015-10-13 |
| Effective Date | 2015-10-13 |
| Expiration Date | 2016-08-31 |
| Refresh Date | 2016-12-04 |
| Street Address | 10 AVALON DR UNIT 3323 |
| City | MILFORD |
| State | CT |
| Zip Code | 06460-8577 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Sainath Gaddam | 10 Avalon Dr Unit 3323, Milford, CT 06460-8577 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Milford Council On Aging | 9 Jepson Drive, Milford, CT 06460 | Public Charity | 2019-06-01 ~ 2020-05-31 |
| James J Melanson | 319 Welch's Point Road, Milford, CT 06460 | Optician | 2020-08-01 ~ 2021-07-31 |
| Robert J Colum | 61 Melba St, Milford, CT 06460 | Professional Engineer | 2020-06-16 ~ 2021-01-31 |
| James E Phillips | 88 Noble Ave, Milford, CT 06460 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Douglas H Gruber | 33 Lincoln Ave, Milford, CT 06460 | Licensed Alcohol and Drug Counselor | 2020-06-01 ~ 2021-05-31 |
| Christine D Rettig | 1 Schooner Lane, Milford, CT 06460 | Physical Therapist | 2020-07-01 ~ 2021-06-30 |
| Golden Dragon Inc | 262 D Quarry Rd, Mildord, CT 06460 | Food Warehouse | ~ |
| Kelli-ann Armstrong | 50 Cherry Street, Milford, CT 06460 | Optometrist | 2020-07-01 ~ 2021-06-30 |
| Mary C Cohen | 9 Stevens Street, Milford, CT 06460 | Notary Public Appointment | 2020-07-01 ~ 2025-06-30 |
| Nicole Wilson | 26 Daggett Street, Milford, CT 06460 | Hairdresser/cosmetician | 2020-08-01 ~ 2022-07-31 |
| Find all Licenses in zip 06460 | |||
| City | MILFORD |
| Zip Code | 06460 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + MILFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Martha Praught | 131 Birch St, Roslindale, MA 02131-3431 | Physician/surgeon | 1987-03-13 ~ 1992-03-31 |
| Martha Lauster | 360 3rd Street Suite 425, San Francisco, CA 94107 | Physician/surgeon | ~ |
| Martha Buitrago Md | 36 Lincoln St, New Haven, CT 06511 | Physician/surgeon | 2002-01-24 ~ 2003-02-28 |
| Martha A Howard Md | 206 Church St, Guilford, CT 06437 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Roy P Simmons | 4315 Martha Ave, Woodlawn, NY 10470 | Physician/surgeon | 2013-07-01 ~ 2014-06-30 |
| Martha Brochin Md | 9 Washington Avenue, Hamden, CT 06518 | Physician/surgeon | 2002-12-19 ~ 2004-02-29 |
| Martha Maria Coetzee Md | 75 Avonwood Rd $88, Avon, CT 06001 | Physician/surgeon | 2006-03-13 ~ 2007-04-30 |
| Martha M Greenwood Md | 111 Founders Plz Ste 400, East Hartford, CT 06108-3240 | Physician/surgeon | 2014-04-01 ~ 2015-03-31 |
| Martha Tepas Desbiens | 33 Germantown Rd, Danbury, CT 06810-5038 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Martha Kushnir | 31 Pointe Rok Drive, Worcester, MA 01604 | Physician/surgeon | 2010-02-01 ~ 2011-01-31 |
Please comment or provide details below to improve the information on MARTHA L BALLESTAS-REVOLLO.
| 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).