# MERIDIAN MEDICAL GROUP PROFESSIONAL CORP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MERIDIAN MEDICAL GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457439572
- **Authorized official:** DR. ALBERT A GOMEZ MD (CEO)
- **Authorized official phone:** (408) 754-8988

## Contact information

- **Practice address:** 1047 E CAPITOL EXPY, SAN JOSE, CA 95121-2415
- **Practice address phone:** (408) 754-8988
- **Practice address fax:** (408) 754-8289
- **Mailing address:** 1047 E CAPITOL EXPY, SAN JOSE, CA 95121-2415
- **Mailing address phone:** (408) 754-8988
- **Mailing address fax:** (408) 754-8289

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A303360 | CA | Yes |

## Other

- **Enumeration date:** 11/02/2006
- **Last updated:** 03/29/2021

## 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 |