NATASHA VICTORIA RODRIGUEZ MANCEBO Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****20

License Status

ACTIVE

Business

First Name

NATASHA

Middle

VICTORIA

Last Name

RODRIGUEZ MANCEBO

Business Name

NATASHA VICTORIA RODRIGUEZ MANCEBO

Original Issue Date

12/12/2019

Effective Date

02/21/2026

Expiration Date

03/01/2028

City

PEORIA

State

Zip

61605

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/21/2026