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General NPI Number Information
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NPI Number | 1265550743
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Entity Type | Individual
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Provider Name | ALEXANDER PAUL IEZZA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 208 CONCOURSE BLVD STE 1
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City | SANTA ROSA
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State | CA
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Zip | 95403-8210
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Country | US
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Telephone | 707-544-3400
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Fax | 707-544-0137
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Provider Business Mailing Address
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Address Line | 950 ALICE LN APT #3
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City | MENLO PARK
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State | CA
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Zip | 94025
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Country | US
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Telephone | 650-248-5443
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A92670
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License Number State | CA
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