Provider Demographics
NPI:1134228752
Name:GOMEZ, ALBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:A
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 ALUM ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-2429
Mailing Address - Country:US
Mailing Address - Phone:408-347-1680
Mailing Address - Fax:408-347-1681
Practice Address - Street 1:1644 ALUM ROCK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-2429
Practice Address - Country:US
Practice Address - Phone:408-347-1680
Practice Address - Fax:408-347-1681
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA303360208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ41448ZOtherBLUE SHIELD PIN
CAGR0070181Medicaid
CAGR0070182Medicaid
CAGR0070180Medicaid
CA00A303360OtherMEDICAL BOARD NUMBER
CAGR0070180Medicaid
CAGR0070182Medicaid
CA770352459OtherTAX ID NUMBER
CA010048251Medicare ID - Type UnspecifiedPALMETTO GBA - RAILROAD
CAGR0070180Medicaid