Provider Demographics
NPI:1306540299
Name:TESTOTHERA
Entity type:Organization
Organization Name:TESTOTHERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDED
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:346-202-6670
Mailing Address - Street 1:9722 GASTON RD STE 150-360
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7941
Mailing Address - Country:US
Mailing Address - Phone:346-202-6670
Mailing Address - Fax:
Practice Address - Street 1:6445 FM 1463 RD STE 140
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4028
Practice Address - Country:US
Practice Address - Phone:346-202-6671
Practice Address - Fax:346-202-6676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty