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Licensing details for: PTL 14794

Name: Theodory, Bassam

License Type: Postgraduate Training License

Primary Status: License Canceled Primary Status Definition

School Name: University of California, Riverside School of Medicine

Graduation Year: 2024

Current Enrolled Postgraduate Training Program

Facility Name: HCA Healthcare Riverside Program

City: Riverside

State: California

Speciality: Radiology-diagnostic

Start Date: 07/01/2025

Anticipated End Date: 06/30/2029

Address of Record

Riverside Community Hospital
4445 Magnolia Ave
RIVERSIDE CA 92501
RIVERSIDE county
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Issuance Date

July 12, 2024

Expiration Date

N/A

Current Date / Time

April 3, 2026
4:13:18 AM

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License Relationships

Postgraduate Training License associated with Physician & Surgeon License

License/Registration Role: Postgraduate Training License

Related Party Role: Physician & Surgeon

Name: Theodory, Bassam

License/Registration Type: Physician's and Surgeon's

License Number: 206651 Primary Status: License Renewed & Current

Address :
8228 Pecan Ave
RANCHO CUCAMONGA CA 91739-9268
SAN BERNARDINO COUNTY

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