Provider Demographics
NPI:1255138517
Name:TBC123 LLC
Entity type:Organization
Organization Name:TBC123 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:EILEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ATLASOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-404-7446
Mailing Address - Street 1:414 TOPAZ TER
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94089-2192
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:414 TOPAZ TER
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94089-2192
Practice Address - Country:US
Practice Address - Phone:650-404-7446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty