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General NPI Number Information
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NPI Number | 1215802723
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Entity Type | Organization
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Legal Business Name | CUSTOM DEZIGNS LLC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 1025 22ND ST S
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City | ST PETERSBURG
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State | FL
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Zip | 33712-2254
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Country | US
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Telephone | 727-564-7786
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Fax |
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Provider Business Mailing Address
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Address Line | 5036 DR MARTIN LUTHER KING JR ST S
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City | ST PETERSBURG
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State | FL
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Zip | 33705-4929
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Country | US
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Telephone | 727-564-7786
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TIFFANY COHEN
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Credential |
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Telephone | 726-564-7786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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