Organization
CENTRAL MEDICAL WELLNESS & REGENERATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALFONSO MORALES-UTRILLA MD (OWNER)
(651) 644-6002
Entity
Organization
Contact information
Practice address
821 RAYMOND AVE STE 230, SAINT PAUL, MN 55114-1503
(651) 644-6002
(651) 647-1647
Mailing address
7595 CURRELL BLVD UNIT 25404, WOODBURY, MN 55125-2569
(651) 644-6002
(651) 647-1647
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
261QP3300X
Pain Clinic/Center
Primary
—
—
Other
Enumeration date
11/05/2020
Last updated
11/05/2020
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