Healthcare Provider Details

I. General information

NPI: 1174140941
Provider Name (Legal Business Name): MARIGLORIA MALDONADO-PUEBLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4503 N 22ND ST
TAMPA FL
33610-6201
US

IV. Provider business mailing address

1101 LUDLOW ST APT 614
PHILADELPHIA PA
19107-4258
US

V. Phone/Fax

Practice location:
  • Phone: 813-738-6684
  • Fax: 813-413-8549
Mailing address:
  • Phone: 813-731-1284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA12318000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT220713
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME182132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: