| Meridian Medical Group Professional Corp | |
|
1047 E Capitol Expy San Jose CA 95121-2415 | |
| (408) 754-8988 | |
| (408) 754-8289 |
| Full Name | Meridian Medical Group Professional Corp |
|---|---|
| Speciality | General Practice |
| Location | 1047 E Capitol Expy, San Jose, California |
| Authorized Official Name and Position | Albert A Gomez (CEO) |
| Authorized Official Contact | 4087548988 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Meridian Medical Group Professional Corp 1047 E Capitol Expy San Jose CA 95121-2415 Ph: (408) 754-8988 | Meridian Medical Group Professional Corp 1047 E Capitol Expy San Jose CA 95121-2415 Ph: (408) 754-8988 |
| NPI Number | 1457439572 |
|---|---|
| Provider Enumeration Date | 11/02/2006 |
| Last Update Date | 03/29/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457439572 | NPI | - | NPPES |
| 880357380 | Other | CA | TAX ID |
| GR0070181 | Medicaid | CA | |
| GR0070182 | Medicaid | CA | |
| 00A303360 | Other | CA | MEDICAL LICENSE NUMBER |
| 1134228752 | Other | CA | NPI NUMBER |
| ZZZ41448Z | Other | CA | BLUE SHIELD NUMBER |
| GR0070180 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A303360 (California) | Primary |
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