MEDICARE: KEVIN MICHAEL IZQUIERDO MD

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	208C00000X	Colon & Rectal Surgery Physician	ME135454	FL
2	208C00000X	Colon & Rectal Surgery Physician	A127272	CA
3	390200000X	Student in an Organized Health Care Education/Training Program
4	208600000X	Surgery Physician	A127272	CA

General Provider Information

NPI Number	:	1922361641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN MICHAEL IZQUIERDO MD

Provider Business Mailing Address
First Line	:	5565 W LAS POSITAS BLVD STE 260
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94588-5807
Country	:	US
Telephone Number	:	925-416-5470
Fax Number	:

Provider Business Practice Location Address
First Line	:	5565 W LAS POSITAS BLVD STE 260
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94588-5807
Country	:	US
Telephone Number	:	925-416-5470
Fax Number	:

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

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	08/27/2025

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