Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Modern Vascular of Glendale, LLC

Organization Family Medicine Physician · NPI 1063947638

Modern Vascular of Glendale, LLC is a Family Medicine Physician in Glendale, Arizona. Registered with an NPI since 2017.

In the registry since
2017
Specialties on file
5
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

11851 N 51st Ave Bldg G
Glendale, AZ 85304
Phone: (818) 949-2634
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Vascular & Interventional Radiology Physician (primary) Taxonomy 2085R0204X
Family Medicine Physician Taxonomy 207Q00000X
Cardiovascular Disease Physician Taxonomy 207RC0000X
Interventional Cardiology Physician Taxonomy 207RI0011X
Podiatrist Taxonomy 213E00000X

Record details

NPI number1063947638
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Yury Gampel — Manager · (818) 880-8605
NPI enumeratedApril 20, 2017
Last updated in NPPESJuly 11, 2018
Mailing address26500 Agoura Rd Ste 102-587, Calabasas, CA 91302-1952

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