OrganizationActive
Modern Vascular of Glendale, LLC
NPI 1063947638 · Vascular & Interventional Radiology Physician · Glendale, AZ
Provider details
- NPI number
- 1063947638
- Entity type
- Organization
- Primary specialty
- Vascular & Interventional Radiology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Yury Gampel, Manager(818) 880-8605
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Family Medicine Physician207Q00000X
Allopathic & Osteopathic Physicians
- Cardiovascular Disease Physician207RC0000X
Allopathic & Osteopathic Physicians
- Interventional Cardiology Physician207RI0011X
Allopathic & Osteopathic Physicians
- Podiatrist213E00000X
Podiatric Medicine & Surgery Service Providers
Practice location
11851 N 51st Ave
Building G
Glendale, AZ 85304
Phone: (818) 949-2634
Approximate (ZIP-level) locationGet directions
Mailing address
26500 Agoura Rd Ste 102-587
Calabasas, CA 91302-1952
Registry dates
- Enumerated
- 2017-04-20
- Last updated
- 2018-07-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.