Provider Demographics
NPI:1003474461
Name:CACTUS PEDIATRIC ORTHOPAEDICS, PLLC
Entity Type:Organization
Organization Name:CACTUS PEDIATRIC ORTHOPAEDICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:HRASKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-551-0300
Mailing Address - Street 1:PO BOX 2767
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-2767
Mailing Address - Country:US
Mailing Address - Phone:480-551-0300
Mailing Address - Fax:
Practice Address - Street 1:1500 S DOBSON RD STE 200
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4724
Practice Address - Country:US
Practice Address - Phone:480-551-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center