Healthcare Provider Details

I. General information

NPI: 1922361641
Provider Name (Legal Business Name): KEVIN MICHAEL IZQUIERDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 W LAS POSITAS BLVD STE 260
PLEASANTON CA
94588-5807
US

IV. Provider business mailing address

5565 W LAS POSITAS BLVD STE 260
PLEASANTON CA
94588-5807
US

V. Phone/Fax

Practice location:
  • Phone: 925-416-5470
  • Fax:
Mailing address:
  • Phone: 925-416-5470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME135454
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA127272
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA127272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: