Healthcare Provider Details

I. General information

NPI: 1740421973
Provider Name (Legal Business Name): ALEXANDER IZMAILOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEKSANDER IZMAYLOVSKIY

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUITION BLVD BLDG 400, SUITE 102
SALINAS CA
93906
US

IV. Provider business mailing address

100 WILSON RD 100
MONTEREY CA
93940-7885
US

V. Phone/Fax

Practice location:
  • Phone: 831-796-1630
  • Fax: 831-754-1660
Mailing address:
  • Phone: 831-649-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA106955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: