Healthcare Provider Details

I. General information

NPI: 1316742992
Provider Name (Legal Business Name): CACTUS BLOOM STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 E GERMANN RD # 15
MESA AZ
85212-5301
US

IV. Provider business mailing address

18451 E AUBREY GLEN RD
QUEEN CREEK AZ
85142-3626
US

V. Phone/Fax

Practice location:
  • Phone: 480-477-4467
  • Fax: 480-781-4896
Mailing address:
  • Phone: 480-332-9729
  • 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: MISTY SHEARER
Title or Position: OWNER
Credential: FNP
Phone: 480-332-9729