Healthcare Provider Details

I. General information

NPI: 1790622264
Provider Name (Legal Business Name): WEST MODESTO COMMUNITY COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 CALIFORNIA AVE
MODESTO CA
95351-2595
US

IV. Provider business mailing address

601 S MARTIN LUTHER KING DR
MODESTO CA
95351-2762
US

V. Phone/Fax

Practice location:
  • Phone: 209-522-6902
  • Fax:
Mailing address:
  • Phone: 209-522-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: PERFECTO MUNOZ
Title or Position: CEO
Credential: MPH, PHD
Phone: 209-522-6902