136*****-**** Dental Hygienist with Local Anesthesia

SIGNATURE OF HOLDER

**/**/****

DIVISION OF PROFESSIONAL LICENSING

ACTIVE LICENSE

ACTIVE LICENSE

Elizabeth F Hermosillo

SIGNATURE OF HOLDER

136*****-**** Dental Hygienist with Local Anesthesia 11/01/2023 05/31/2026

ELIZABETH F HERMOSILLO

12670 COMETA AVE

SAN FERNANDO CA 91340

05/31/2026

Elizabeth F Hermosillo

IMPORTANT LICENSURE REMINDERS:

Your license is valid until the expiration date listed on this form. Approximately 60 days prior to this expiration you will receive a renewal notice by email.

Please note the address listed below is your public address of record for the Division. All future correspondence from the Division will be either mailed to this address or emailed to the email on record. If you move or change your email, it is your responsibility to keep DOPL informed. Maintaining a current address AND email with DOPL is the easiest way to ensure continuous licensure. Please visit our web site at

www.dopl.utah.gov should you have any

questions in the future.