Healthcare Provider Details

I. General information

NPI: 1285439083
Provider Name (Legal Business Name): COLEEN MUNOZ LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 KINGS PARK LN
MODESTO CA
95355-8681
US

IV. Provider business mailing address

2813 KINGS PARK LN
MODESTO CA
95355-8681
US

V. Phone/Fax

Practice location:
  • Phone: 209-499-4492
  • Fax:
Mailing address:
  • Phone: 209-499-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: