DEPARTMENT OF INSURANCE

Name	Rebaza, Carlos	DOIID	931333	NAIC NPN	16154550

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Inactive	Non Resident	Agent	Life	9/29/2016	9/30/2022
Inactive	Non Resident	Agent	Health	9/29/2016	9/30/2022

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

No License Renewal Information

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	64 Sagamore Road Apt F8 Bronxville, NY 10708
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(646) 234-9991