CARLOS RODOLFO BOCANEGRA CORDOVA Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085007669

License Status

ACTIVE

Business

First Name

CARLOS

Middle

RODOLFO

Last Name

BOCANEGRA CORDOVA

Business Name

CARLOS RODOLFO BOCANEGRA CORDOVA

Original Issue Date

05/26/2020

Effective Date

02/15/2026

Expiration Date

03/01/2028

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

02/15/2026