Healthcare Provider Details

I. General information

NPI: 1942010194
Provider Name (Legal Business Name): CLEARSCAN MOBILE XRAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1774 FOREST CT
CONCORD CA
94521-1147
US

IV. Provider business mailing address

1774 FOREST CT
CONCORD CA
94521-1147
US

V. Phone/Fax

Practice location:
  • Phone: 925-665-4127
  • Fax:
Mailing address:
  • Phone: 925-665-4127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: CHRISSIE GONZALES SMITH
Title or Position: CEO
Credential:
Phone: 925-665-4127