LAURA V LARREA MANTILLA (Credential# 1488623) is licensed (Resident Physician) with Connecticut Department of Consumer Protection. The license effective date is June 28, 2017. The license expiration date date is June 30, 2020. The license status is ACTIVE.
LAURA V LARREA MANTILLA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.058018-RES. The credential type is resident physician. The effective date is June 28, 2017. The expiration date is June 30, 2020. The business address is 844 W Center St Apt 2, Rochester, MN 55902-6226. The current status is active.
| Licensee Name | LAURA V LARREA MANTILLA |
| Credential ID | 1488623 |
| Credential Number | 1.058018-RES |
| Credential Type | Resident Physician |
| Credential SubCategory | RES |
| Business Address |
844 W Center St Apt 2 Rochester MN 55902-6226 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2017-06-28 |
| Effective Date | 2017-06-28 |
| Expiration Date | 2020-06-30 |
| Refresh Date | 2018-02-01 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1424894 | CSP.0065474 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2017-05-23 | 2017-05-23 - 2019-02-28 | LAPSED |
| Street Address | 844 W CENTER ST APT 2 |
| City | ROCHESTER |
| State | MN |
| Zip Code | 55902-6226 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Eunsook Samantha Lee | 910 Wicklow Lane Sw, Rochester, MN 55902 | Pharmacist | 2018-02-01 ~ 2020-01-31 |
| Pradeep K Siddappa | 620 2nd St Sw 311, Rochester, MN 55902 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Joshua L Shones | 635 36th St Sw, Rochester, MN 55902 | Professional Engineer | 2017-02-01 ~ 2018-01-31 |
| Hildon House Usa | 1421 20th St S W, Rochester, MN 55902 | Non-alcoholic Beverage & Water Bottlers | 1997-06-10 ~ 1998-06-30 |
| Manuel A Moreno Gonzales | 159 Grandeville Road Sw Vnh22, Rochester, MN 55902 | Controlled Substance Registration for Practitioner | 2016-06-29 ~ 2017-02-28 |
| Eileen F Hawkins | 844 7th Ave Sw, Rochester, MN 55902 | Registered Nurse | 1993-05-25 ~ 1994-07-31 |
| Kenneth A Iczkowski | 621 1st St S.w., Rochester, MN 55902 | Physician/surgeon | ~ 1996-07-31 |
| Craig A Hawkins | 844 7th Avenue Sw, Rochester, MN 55902 | Physician/surgeon | 1994-02-25 ~ 1995-01-31 |
| Heilia L Vines | 2804 2nd Street Sw, Rochester, MN 55902 | Registered Nurse | 2007-01-08 ~ 2008-01-31 |
| Lynette J Krakowski | 2845 Fox Valley Dr, Rochester, MN 55902 | Registered Nurse | 1994-06-16 ~ 1995-06-30 |
| Find all Licenses in zip 55902 | |||
| City | ROCHESTER |
| Zip Code | 55902 |
| License Type | Resident Physician |
| License Type + County | Resident Physician + ROCHESTER |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Alexander Almeida Larrea | 114 Woodland St, Hartford, CT 06105-1208 | Resident Physician | 2018-06-18 ~ 2022-06-17 |
| Laura Rotundo | 20 York St, New Haven, CT 06510-3220 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
| Laura M Khandjian | 20 York St, New Haven, CT 06510-3220 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
| Laura T Forero | 156 W Main St, Greenville, PA 16125-2443 | Resident Physician | 2017-04-10 ~ 2022-06-30 |
| Laura Tafuri | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2019-06-24 ~ 2023-06-30 |
| Laura Chin | 81 Orange St, New Haven, CT 06510 | Resident Physician | 2017-07-01 ~ 2018-06-30 |
| Laura K Rein | 20 York St, New Haven, CT 06510-3220 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
| Laura Ragoonanan | 20 York Street, New Haven, CT 06510 | Resident Physician | 2019-04-23 ~ 2019-05-20 |
| Laura Rachel Glick | 20 York St, New Haven, CT 06510-3220 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
| Laura A Cataldi | 10 Kendall Green Dr, Milford, CT 06461-3068 | Resident Physician | 2014-10-29 ~ 2020-06-30 |
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| 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).