Healthcare Provider Details

I. General information

NPI: 1285305524
Provider Name (Legal Business Name): MARIA TERESA PONGIBOVE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/08/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 AVE HOSTOS EDIFICIO MEDICAL EMPORIUM 1 SUITE 110
MAYAGUEZ PR
00680-1502
US

IV. Provider business mailing address

351 AVE HOSTOS EDIFICIO MEDICAL EMPORIUM 1, SUITE 110
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-7740
  • Fax: 787-652-4525
Mailing address:
  • Phone: 787-834-7740
  • Fax: 787-652-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24034
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: