Healthcare Provider Details

I. General information

NPI: 1699751008
Provider Name (Legal Business Name): MASSIMO TESTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 S 900 E
SALT LAKE CITY UT
84102-2310
US

IV. Provider business mailing address

4893 CHARLAIS LN
PARK CITY UT
84098-7557
US

V. Phone/Fax

Practice location:
  • Phone: 385-282-2700
  • Fax: 385-282-2701
Mailing address:
  • Phone: 435-604-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberA86451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: