Healthcare Provider Details

I. General information

NPI: 1710472766
Provider Name (Legal Business Name): JOSE IGNACIO SANDOVAL CONSUEGRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E37 CALLE HERNANDEZ CARRION
MANATI PR
00674-4622
US

IV. Provider business mailing address

10 SUNDOWN ST
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD489924
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number24873
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: