Healthcare Provider Details

I. General information

NPI: 1003474461
Provider Name (Legal Business Name): CACTUS PEDIATRIC ORTHOPAEDICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 S MERCY RD STE 107
GILBERT AZ
85297-0420
US

IV. Provider business mailing address

PO BOX 2767
SCOTTSDALE AZ
85252-2767
US

V. Phone/Fax

Practice location:
  • Phone: 480-551-0300
  • Fax: 480-649-3746
Mailing address:
  • Phone: 480-551-0300
  • Fax: 480-649-3746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORRAINE ORTEGA
Title or Position: OFFICE MANAGER
Credential:
Phone: 480-551-0300