Provider Demographics
NPI:1740421973
Name:IZMAILOV, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:IZMAILOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEKSANDER
Other - Middle Name:
Other - Last Name:IZMAYLOVSKIY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 WILSON RD
Mailing Address - Street 2:100
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7885
Mailing Address - Country:US
Mailing Address - Phone:831-649-1000
Mailing Address - Fax:
Practice Address - Street 1:1441 CONSTITUITION BLVD
Practice Address - Street 2:BLDG 400, SUITE 102
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906
Practice Address - Country:US
Practice Address - Phone:831-796-1630
Practice Address - Fax:831-754-1660
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106955207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease