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Licensing details for: A 198163

Name: Nagamoto, Jackson David

License Type: Physician and Surgeon A

Primary Status: License Renewed & Current Primary Status Definition

School Name: University of Central Florida

Graduation Year: 2023

Address of Record

4445 Magnolia Ave
RIVERSIDE CA 92501-4135
RIVERSIDE county
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Issuance Date

August 2, 2024

Expiration Date

October 31, 2026

Current Date / Time

April 3, 2026
4:52:30 AM

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License Relationships

Postgraduate Training License associated with Physician & Surgeon License

License/Registration Role: Physician & Surgeon

Related Party Role: Postgraduate Training License

Name: Nagamoto, Jackson David

License/Registration Type: Postgraduate Training License

License Number: 12596 Primary Status: License Canceled

Address :
4445 Magnolia Ave
RIVERSIDE CA 92501-4135
RIVERSIDE COUNTY

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Survey Information

The following information is self-reported by the licensee and has not been verified by the Board.

No AB 133 Survey Information Provided by Licensee

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