Provider Demographics
NPI:1578686754
Name:AYELA-UWANGUE, TERESA M (MD)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:M
Last Name:AYELA-UWANGUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:M
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2310 W MULBERRY DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6738
Mailing Address - Country:US
Mailing Address - Phone:585-967-2341
Mailing Address - Fax:
Practice Address - Street 1:3530 S VAL VISTA DR STE A111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7319
Practice Address - Country:US
Practice Address - Phone:480-670-2400
Practice Address - Fax:480-870-2019
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42902208000000X, 207R00000X
PAMT189001208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ520025Medicaid