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Organization
MERIDIAN MEDICAL GROUP PROFESSIONAL CORP
Active
Organization
MERIDIAN MEDICAL GROUP PROFESSIONAL CORP
Active
Other names
MERIDIAN MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALBERT A GOMEZ MD (CEO)
(408) 754-8988
Entity
Organization
Contact information
Practice address
1047 E CAPITOL EXPY, SAN JOSE, CA 95121-2415
(408) 754-8988
(408) 754-8289
Mailing address
1047 E CAPITOL EXPY, SAN JOSE, CA 95121-2415
(408) 754-8988
(408) 754-8289
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A303360
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A303360
MEDICAL LICENSE NUMBER
CA
01
—
1134228752
NPI NUMBER
CA
01
—
880357380
TAX ID
CA
05
—
GR0070180
—
CA
05
—
GR0070181
—
CA
05
—
GR0070182
—
CA
01
—
ZZZ41448Z
BLUE SHIELD NUMBER
CA
Enumeration date
11/02/2006
Last updated
03/29/2021
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