Basic Information
| Provider Information | |||||||||
| NPI: | 1164544730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TESTA | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | R, | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 W FRYE RD | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852246255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808959555 | ||||||||
| FaxNumber: | 4808959494 | ||||||||
| Practice Location | |||||||||
| Address1: | 1187 E COTTONWOOD LN STE B | ||||||||
| Address2: | |||||||||
| City: | CASA GRANDE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851222957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208361000 | ||||||||
| FaxNumber: | 5208366515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 36809 | AZ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 049347 | 05 | AZ | MEDICAID |