MODERN VASCULAR OF GLENDALE, LLC (NPI# 1063947638) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063947638 |
| Entity Type | Organization |
| Organization Name | MODERN VASCULAR OF GLENDALE, LLC |
| Practice Address |
11851 N 51st Ave Building G Glendale AZ 85304 |
| Mailing Address |
26500 Agoura Rd Ste 102-587 Calabasas CA 91302-1952 |
| Practice Telephone | 8189492634 |
| Mailing Telephone | 8188808605 |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2018-07-11 |
| Authorized Official Name | YURY GAMPEL (MANAGER) |
| Authorized Official Telephone | 8188808605 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
Allopathic & Osteopathic Physicians | ||
| N | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers | ||
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians |
| Street Address |
11851 N 51ST AVE BUILDING G |
| City | GLENDALE |
| State | AZ |
| Zip Code | 85304 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629049978 | Jason Reinhart | Specialist | 11851 N 51st Ave, Ste 210, Glendale, AZ 85304-2809 | 2006-01-26 |
| 1336554542 | Kathy Vu Ngo, Pllc | Optometrist | 11851 N 51st Ave, Suite 120, Glendale, AZ 85304-2809 | 2014-06-26 |
| 1245645456 | Kelvin Ngo Dmd & Associates, Pllc | Dentist | 11851 N 51st Ave, #120, Glendale, AZ 85304-2809 | 2014-06-26 |
| 1073778601 | Kathy Vu | Optometrist | 11851 N 51st Ave, Suite 120, Glendale, AZ 85304-2809 | 2008-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386254027 | J & B Assisted Living, Inc. D/b/a J & B Behavioral Health II | Substance Abuse Rehabilitation Facility | 6613 W. Pershing Avenue, Glendale, AZ 85304 | 2020-08-07 |
| 1194214015 | Vema Corporation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4309 W Corrine Dr, Glendale, AZ 85304 | 2018-05-07 |
| 1962929224 | Glendale Surgery Center | Clinic/Center | 11851 North 51st Ave, Suite G, Glendale, AZ 85304 | 2017-08-28 |
| 1073941092 | Megan Lorenzen | Occupational Therapist | 5834 W. Bloomfield Rd., Glendale, AZ 85304 | 2013-10-30 |
| 1396178380 | Danielle Marie Wiles | Registered Nurse | 12901 W. 63rd Avenue, Glendale, AZ 85304 | 2013-08-14 |
| 1780017848 | Pedram Nazari | Pharmacist | 4811 North 83rd Avenue, Glendale, AZ 85304 | 2013-08-13 |
| 1740558022 | Krunal Patel | Obstetrics & Gynecology | 5605 W Eugie Ave Ste 111, Glendale, AZ 85304 | 2011-12-01 |
| 1730499609 | Laura A Truax | Physician Assistant | 11851 N. 51st Ave, Ste F-110, Glendale, AZ 85304 | 2010-10-13 |
| 1760698419 | Suhir Bitar | Pediatrics | 13625 N 59th Ave, Glendale, AZ 85304 | 2007-05-16 |
| 1497967293 | Pam Rubbone | Psychologist | 4650 West Sweetwater Ave., Glendale, AZ 85304 | 2007-05-04 |
| Find all providers in zip 85304 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205138328 | Nick Dzebolo Md Inc | Radiology | 1030 S Glendale Ave, Suite 200, Glendale, CA 91205-2866 | 2010-11-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770139958 | Banner Imaging Services LLC | Radiology | 10474 W Thunderbird Blvd Ste 100, Sun City, AZ 85351-3015 | 2019-08-14 |
| 1629535091 | Comprehensive Interventional Care Centers, Pllc | Radiology | 10555 N Tatum Blvd Ste A101, Paradise Valley, AZ 85253-1096 | 2019-02-21 |
| 1720542137 | Priority Interventional Radiology LLC | Radiology | 8787 N Scottsdale Rd Ste 105, Scottsdale, AZ 85253-2338 | 2019-01-30 |
| 1972004489 | Smi Imaging, LLC | Radiology | 6740 E Camelback Rd Ste 100, Scottsdale, AZ 85251-2096 | 2018-02-21 |
| 1134633837 | Association of University Radiologists, PC | Radiology | 3900 N Camino Ojo De Agua, Tucson, AZ 85749-7819 | 2017-11-17 |
| 1295262160 | Vein Ablation Specialists and Consultants LLC | Radiology | 7047 E Greenway Pkwy Ste 250, Scottsdale, AZ 85254-8113 | 2017-05-22 |
| 1588029672 | Advanced Vein Institute of Arizona, LLC | Radiology | 2155 E Conference Dr Ste 101, Tempe, AZ 85284-2604 | 2015-12-16 |
| 1649681842 | Vascular Vein & Imaging Center | Radiology | 2899 S Hope Dr, Yuma, AZ 85364-7487 | 2014-05-11 |
| 1255601613 | High Desert Radiology, P.C. | Radiology | 3439 Southern Vista Dr, Kingman, AZ 86401-0630 | 2012-01-03 |
| 1447316054 | Gnr Ventures, LLC | Radiology | 9440 E Ironwood Square Dr Ste 110, Scottsdale, AZ 85258-4569 | 2006-12-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.