Organization
CUSTOM WIG WORLD 4 KIDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTOINETTE LASTER-SMITH (OWNER)
(949) 295-1503
Entity
Organization
Contact information
Practice address
9270 QUARTERHORSE LN UNIT 404, LAS VEGAS, NV 89178-6344
(949) 295-1503
Mailing address
9270 QUARTERHORSE LN UNIT 404, LAS VEGAS, NV 89178-6344
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
05/31/2024
Last updated
05/31/2024
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