Healthcare Provider Details

I. General information

NPI: 1013835347
Provider Name (Legal Business Name): CACTUS ROSE AESTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 CHASE CREEK STREET
CLIFTON AZ
85533
US

IV. Provider business mailing address

236 CHASE CREEK STREET
CLIFTON AZ
85533
US

V. Phone/Fax

Practice location:
  • Phone: 928-322-5386
  • Fax:
Mailing address:
  • Phone: 928-322-5386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NEVA CORBELL
Title or Position: OWNER
Credential: FNP-C
Phone: 520-305-5819