Provider Demographics
NPI:1114120334
Name:TESTA, ALVARO JAVIER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVARO
Middle Name:JAVIER
Last Name:TESTA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1303
Mailing Address - Country:US
Mailing Address - Phone:602-258-9900
Mailing Address - Fax:602-258-9904
Practice Address - Street 1:3367 S MERCY RD STE 210
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7604
Practice Address - Country:US
Practice Address - Phone:480-850-2098
Practice Address - Fax:480-850-2097
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2022-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48507208200000X
AZ408632086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17858054Medicaid
AZ809590Medicaid
COCOA101640Medicare UPIN
AZZ159282Medicare PIN
COCOA103356Medicare PIN