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MODERN VASCULAR OF GLENDALE, LLC
NPI 1063947638
Radiology - Vascular & Interventional Radiology in Glendale, AZ

Active since April 20, 2017
11851 N 51ST AVE, BUILDING G, GLENDALE, AZ 85304(818) 949-2634 Get Directions Write a Review

NPPES record last updated: July 11, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 11, 2018, Jun 27, 2017, Apr 20, 2017 (3 updates tracked since 2017).

About Modern Vascular Of Glendale, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MODERN VASCULAR OF GLENDALE, LLC (NPI 1063947638) is a healthcare organization registered as a vascular & interventional radiology in Glendale, Arizona and active in the NPI registry since April 2017. The organization lists Yury Gampel, Manager, as its authorized official.

NPPES Registry Identity

NPI1063947638
Entity TypeOrganization
Primary Taxonomy2085R0204X
Legal Business NameMODERN VASCULAR OF GLENDALE, LLC
Location Address11851 N 51ST AVE, BUILDING GGlendale, AZ 85304
Mailing Address26500 Agoura Rd Ste 102-587Calabasas, CA 91302-1952 · (818) 880-8605
Phone(818) 949-2634
Organization SubpartNo
Authorized OfficialYury GampelManager · (818) 880-8605
Enumeration DateApril 20, 2017
Last NPPES UpdateJuly 11, 20183 updates tracked since enumeration
✔ NPI 1063947638 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyRadiology · Vascular & Interventional RadiologyAllopathic & Osteopathic Physicians
Taxonomy Code2085R0204X
Definition
A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging.
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X
Also ListedInternal Medicine · Interventional CardiologyTaxonomy 207RI0011X
Also ListedPodiatristTaxonomy 213E00000X
11851 N 51ST AVE, Glendale, AZ 85304
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 03D2170990

Modern Vascular Of Glendale · Glendale, AZ
Expired · Aug 9, 2026
CLIA Number03D2170990
Laboratory TypeOutpatient Treatment Cent
Certificate Effective DateAugust 10, 2024
Certificate Expiration DateAugust 9, 2026
Laboratory DirectorPatrick E. Duffy
Laboratory Phone(602) 362-3035
Laboratory LocationModern Vascular Of Glendale11851 N 51st Ave Ste G-140, Glendale, AZ 85304
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

THOMAS JOHN KNUTSON MD
Psychiatry & Neurology (Psychiatry)
11851 N 51ST AVE
GLENDALE, AZ 85304
Maricopa County (480) 882-4545
CHELSEA ELIZABETH MANALESE FNP
Nurse Practitioner (Family)
11851 N 51ST AVE
GLENDALE, AZ 85304
Maricopa County (480) 882-4545
KATHY VU O.D.
Optometrist
11851 N 51ST AVE, SUITE 120
GLENDALE, AZ 85304
Maricopa County (623) 414-6476
KELVIN NGO DMD & ASSOCIATES, PLLC
Dentist
11851 N 51ST AVE, #120
GLENDALE, AZ 85304
Maricopa County (623) 419-5683
KATHY VU NGO, PLLC
Optometrist
11851 N 51ST AVE, SUITE 120
GLENDALE, AZ 85304
Maricopa County (623) 414-6476
BRIENNA MARIE CULNAN
Physical Therapist
11851 N 51ST AVE
GLENDALE, AZ 85304
Maricopa County (623) 934-1154
JASON REINHART DO
Psychiatry & Neurology (Neurology)
11851 N 51ST AVE, STE 210
GLENDALE, AZ 85304
Maricopa County (855) 506-3876

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Modern Vascular Of Glendale, LLC's NPI number?

The NPI number for Modern Vascular Of Glendale, LLC is 1063947638. It was assigned to this organization in the NPPES registry on April 20, 2017.

Where is Modern Vascular Of Glendale, LLC located?

Modern Vascular Of Glendale, LLC is located at 11851 N 51st Ave Building G, Glendale, AZ 85304. The listed phone number is (818) 949-2634.

What is Modern Vascular Of Glendale, LLC's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Vascular & Interventional Radiology, with taxonomy code 2085R0204X.

When was this NPI record last updated?

The NPPES record for Modern Vascular Of Glendale, LLC was last updated on July 11, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.