Provider Demographics
NPI:1528480779
Name:CUERO ANESTHESIA INC.
Entity type:Organization
Organization Name:CUERO ANESTHESIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ANESTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:GOOSBY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:715-688-9465
Mailing Address - Street 1:1041 E WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BARRON
Mailing Address - State:WI
Mailing Address - Zip Code:54812-1763
Mailing Address - Country:US
Mailing Address - Phone:715-688-9465
Mailing Address - Fax:
Practice Address - Street 1:1390 E YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8221
Practice Address - Country:US
Practice Address - Phone:209-580-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1720367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty