Healthcare Provider Details

I. General information

NPI: 1578686754
Provider Name (Legal Business Name): TERESA M AYELA-UWANGUE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. TERESA M JONES

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 S VAL VISTA DR STE A111
GILBERT AZ
85297-7319
US

IV. Provider business mailing address

2310 W MULBERRY DR
CHANDLER AZ
85286-6738
US

V. Phone/Fax

Practice location:
  • Phone: 480-670-2400
  • Fax: 480-870-2019
Mailing address:
  • Phone: 585-967-2341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number42902
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42902
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT189001
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: