The holder whose full name is Portalatin, Meredith,come from Bajadero PR,hold the Temporary MD Permit license(NO.99057341A) which status is Superceded.
| Name | Portalatin, Meredith |
|---|---|
| License Number | 99057341A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Bajadero |
| State | PR |