Indiana
Professional Licensing Agency
Juanito Fajardo Dalisan
Controlled Substance Registration - Physician
License number
01038106B
Date granted
04/10/1991
Date expires
10/31/2013
Class
Controlled Substance Registration - Physician
Status
Expired
Address
Juanito Fajardo Dalisan, 1049 Royal Dublin Lane, Dyer IN 46311-1280
indianalicensing.org
ID 5844382
LAST UPDATED 2024-03-18 00:44:13 UTC
LAST UPDATED 2024-03-18 00:44:13 UTC
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