Provider Demographics
NPI:1356443923
Name:TESTA, ROBERT LEO (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEO
Last Name:TESTA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39324
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-3324
Mailing Address - Country:US
Mailing Address - Phone:253-983-9390
Mailing Address - Fax:253-983-0066
Practice Address - Street 1:11306 BRIDGEPORT WAY SW STE D
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3037
Practice Address - Country:US
Practice Address - Phone:253-983-9390
Practice Address - Fax:253-983-0066
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOA60245584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant