Provider Demographics
NPI:1184342818
Name:TASOBB, LLC
Entity type:Organization
Organization Name:TASOBB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEIROZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-910-2690
Mailing Address - Street 1:135 N RIVER DR UNIT E
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-1906
Mailing Address - Country:US
Mailing Address - Phone:404-910-2690
Mailing Address - Fax:
Practice Address - Street 1:10779 ALPHARETTA HWY
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5677
Practice Address - Country:US
Practice Address - Phone:404-910-2690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier