MODERN VASCULAR OF GLENDALE LLC NPI 1063947638

NPI Information

MODERN VASCULAR OF GLENDALE, LLC is a vascular and interventional radiology radiology in Glendale, AZ. The provider is a radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. MODERN VASCULAR OF GLENDALE, LLC NPI is 1063947638. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

11851 N 51ST AVE
BUILDING G
GLENDALE, AZ
ZIP 85304
Phone: (818) 949-2634

The provider's authorized official is Yury Gampel .
The authorized official title is Manager and has the following contact phone number (818) 880-8605.

The CLIA number assigned to this NPI record is 03D2170990 - other - outpatient treatment cent with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/20/2017 and was last updated on 7/11/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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