MEDICARE: ROBERT LEO TESTA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	OA60245584	WA

General Provider Information

NPI Number	:	1356443923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT LEO TESTA PA-C

Provider Business Mailing Address
First Line	:	PO BOX 39324
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98496-3324
Country	:	US
Telephone Number	:	253-983-9390
Fax Number	:	253-983-0066

Provider Business Practice Location Address
First Line	:	11306 BRIDGEPORT WAY SW STE D
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3037
Country	:	US
Telephone Number	:	253-983-9390
Fax Number	:	253-983-0066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	01/12/2015

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