Provider Demographics
NPI:1316742992
Name:CACTUS BLOOM STUDIO
Entity type:Organization
Organization Name:CACTUS BLOOM STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEARER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:480-332-9729
Mailing Address - Street 1:18451 E AUBREY GLEN RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-3626
Mailing Address - Country:US
Mailing Address - Phone:480-332-9729
Mailing Address - Fax:
Practice Address - Street 1:8950 E GERMANN RD # 15
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-5301
Practice Address - Country:US
Practice Address - Phone:480-477-4467
Practice Address - Fax:480-781-4896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center