Organization
MODERN VASCULAR - NAVAJO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YURY GAMPEL (MANAGER)
(818) 880-8605
Entity
Organization
Contact information
Practice address
7800 CONSTITUTION AVE NE, ALBUQUERQUE, NM 87110-7552
(505) 278-9160
(505) 278-9170
Mailing address
26500 AGOURA RD STE 102-587, CALABASAS, CA 91302-1952
(818) 880-8605
(818) 749-7616
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
213E00000X
Podiatrist
—
—
Other
Enumeration date
05/31/2018
Last updated
04/05/2019
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