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General NPI Number Information
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NPI Number | 1316742992
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Entity Type | Organization
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Legal Business Name | CACTUS BLOOM STUDIO
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 8950 E GERMANN RD # 15
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City | MESA
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State | AZ
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Zip | 85212-5301
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Country | US
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Telephone | 480-477-4467
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Fax | 480-781-4896
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Provider Business Mailing Address
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Address Line | 18451 E AUBREY GLEN RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-3626
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Country | US
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Telephone | 480-332-9729
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISTY SHEARER
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Credential | FNP
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Telephone | 480-332-9729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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