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Organization
MODERN VASCULAR OF MESA, LLC
Active
Organization
MODERN VASCULAR OF MESA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM MURPHY (VP OPERATIONS)
(818) 880-8605
Entity
Organization
Contact information
Practice address
535 E MCKELLIPS RD STE 111, MESA, AZ 85203
(480) 223-1333
Mailing address
26500 AGOURA RD STE 102-587, CALABASAS, CA 91302-1952
(818) 880-8605
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
NULL
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
NULL
207RI0011X
Interventional Cardiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
NULL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
213E00000X
Podiatrist
—
NULL
213E00000X
Podiatrist
—
—
Other
Enumeration date
04/20/2017
Last updated
07/11/2018
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