Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 48507 | CO |
N | 208600000X | Surgeon | 48507 | CO |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 40863 | AZ |
NPI | 1114120334 |
---|---|
Provider Name | Dr. Alvaro Javier Testa JR. |
First Address | Mesa, AZ 85202-7941 |
Second Address | Gilbert, AZ 85297-7604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 11/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17858054 | (05) | CO |
809590 | (05) | AZ |
COA101640 | (02) | CO |