Modern Vascular of Sun City, LLC

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

Legal business name

MODERN VASCULAR OF SUN CITY, LLC

Practice address

14780 W Mountain View Blvd Ste 120
Surprise, AZ 85374-7280

Phone

(602) 892-0917

Fax

(602) 842-7106

NPI assigned

Jan 31, 2019

Last updated

Jan 31, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yury Gampel

Title

Manager

Phone

(818) 880-8605

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548892800000",
    "number": "1083179378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26500 AGOURA RD STE 102-587",
            "city": "CALABASAS",
            "state": "CA",
            "postal_code": "913021952",
            "telephone_number": "818-880-8605",
            "fax_number": "818-579-7916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14780 W MOUNTAIN VIEW BLVD STE 120",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853747280",
            "telephone_number": "602-892-0917",
            "fax_number": "602-842-7106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN VASCULAR OF SUN CITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-31",
        "last_updated": "2019-01-31",
        "status": "A",
        "authorized_official_last_name": "GAMPEL",
        "authorized_official_first_name": "YURY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "818-880-8605"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2471V0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Vascular-Interventional Technology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Joseph Mizell, PA-C
• MNM Dental Studio PLLC
• Moahk Behavioral Home LLC (none)
• Moc Surprise, LLC (Rapid Recovery From Mainstreet Health)
• Modern Sports Medicine LLC
• Melissa Faye Moget, OTD, OTR/L
• Julie Ann Mohline
• Richard Dawson Mohline
• Georgeta Moisiu
• Estera Moldovan, LAC

• Vascular & Interventional Radiology Physician in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Vascular & Interventional Radiology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.