Individual
JOSE IGNACIO SANDOVAL CONSUEGRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2315 MYRTLE ST STE L90, ERIE, PA 16502-4607
(814) 452-7575
Mailing address
2315 MYRTLE ST STE L90, ERIE, PA 16502-4607
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
MD489924
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16545387
CAQH
—
Enumeration date
06/22/2018
Last updated
07/29/2025
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