# FORT WORTH VASCULAR SPECIALISTS CORP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396370334
- **Authorized official:** YURY GAMPEL (MANAGER)
- **Authorized official phone:** (818) 880-8605

## Contact information

- **Practice address:** 5750 STRATUM DR, FORT WORTH, TX 76137-2757
- **Practice address phone:** (817) 989-2580
- **Practice address fax:** (817) 989-6555
- **Mailing address:** 26500 AGOURA RD STE 102-587, CALABASAS, CA 91302-1952
- **Mailing address phone:** (818) 880-8605
- **Mailing address fax:** (818) 579-7916

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | Yes |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | Yes |
| 2471V0106X | Vascular-Interventional Technology Radiologic Technologist | — | NULL | — |
| 2471V0106X | Vascular-Interventional Technology Radiologic Technologist | — | — | — |

## Other

- **Enumeration date:** 03/10/2020
- **Last updated:** 06/05/2020