Provider Demographics
NPI:1710472766
Name:SANDOVAL CONSUEGRA, JOSE IGNACIO
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:IGNACIO
Last Name:SANDOVAL CONSUEGRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13-15 SANTANDER
Mailing Address - Street 2:URB TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-241-6692
Mailing Address - Fax:
Practice Address - Street 1:SECTION OF NEUROLOGICAL SURGERY, UNIVERSITY OF PR,
Practice Address - Street 2:MEDICAL SCIENCE CAMPUS, AVE. AMERICO MIRANDA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program