Healthcare Provider Details

I. General information

NPI: 1083766547
Provider Name (Legal Business Name): ALL CUSTOM CORSETS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2137 SW 8TH ST
MIAMI FL
33135-3319
US

IV. Provider business mailing address

2137 SW 8TH ST
MIAMI FL
33135-3319
US

V. Phone/Fax

Practice location:
  • Phone: 305-541-5858
  • Fax: 305-541-1199
Mailing address:
  • Phone: 305-541-5858
  • Fax: 305-541-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberORF129
License Number StateFL

VIII. Authorized Official

Name: HAYDEE QUIRANTES
Title or Position: PRESIDENT
Credential:
Phone: 305-541-5858