CARLOS RODOLFO BOCANEGRA CORDOVA Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****99

License Status

ACTIVE

Business

First Name

CARLOS

Middle

RODOLFO

Last Name

BOCANEGRA CORDOVA

Business Name

CARLOS RODOLFO BOCANEGRA CORDOVA

Original Issue Date

06/28/2022

Effective Date

02/15/2026

Expiration Date

03/01/2028

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

02/15/2026