Healthcare Provider Details

I. General information

NPI: 1982667564
Provider Name (Legal Business Name): TEDDY VILLEGAS DELA CRUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S AVENUE A
YUMA AZ
85364-7127
US

IV. Provider business mailing address

4722 N 24TH ST STE 100
PHOENIX AZ
85016-4838
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-7661
  • Fax:
Mailing address:
  • Phone: 602-839-7412
  • Fax: 602-839-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number30238
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberC50232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: