Provider Demographics
NPI:1285439083
Name:MUNOZ, COLEEN (LPT)
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 KINGS PARK LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-8681
Mailing Address - Country:US
Mailing Address - Phone:209-499-4492
Mailing Address - Fax:
Practice Address - Street 1:2813 KINGS PARK LN
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-8681
Practice Address - Country:US
Practice Address - Phone:209-499-4492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician