Healthcare Provider Details

I. General information

NPI: 1891649968
Provider Name (Legal Business Name): RADIANT MOBILE IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 FERNANDES ST
MODESTO CA
95355-1547
US

IV. Provider business mailing address

1705 FERNANDES ST
MODESTO CA
95355-1547
US

V. Phone/Fax

Practice location:
  • Phone: 209-222-8812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MELEALOHA REDOBLE
Title or Position: CO-CEO
Credential:
Phone: 209-222-8812