Provider Demographics
NPI:1083766547
Name:ALL CUSTOM CORSETS INC
Entity Type:Organization
Organization Name:ALL CUSTOM CORSETS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAYDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIRANTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-541-5858
Mailing Address - Street 1:2137 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3319
Mailing Address - Country:US
Mailing Address - Phone:305-541-5858
Mailing Address - Fax:305-541-1199
Practice Address - Street 1:2137 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3319
Practice Address - Country:US
Practice Address - Phone:305-541-5858
Practice Address - Fax:305-541-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORF129335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL028612500Medicaid
FL0673130001Medicare NSC