Healthcare Provider Details

I. General information

NPI: 1275835605
Provider Name (Legal Business Name): TURLOCK ANESTHESIA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 DELBON AVE
TURLOCK CA
95382-2016
US

IV. Provider business mailing address

PO BOX 636990
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-4200
  • Fax:
Mailing address:
  • Phone: 412-937-5846
  • Fax: 770-776-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN GOTTLIEB
Title or Position: CEO
Credential: M.D.
Phone: 561-289-5010