Provider Demographics
NPI:1376166496
Name:CENTRAL MEDICAL WELLNESS INC
Entity Type:Organization
Organization Name:CENTRAL MEDICAL WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES-UTRILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-730-5196
Mailing Address - Street 1:7595 CURRELL BLVD UNIT 25404
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2569
Mailing Address - Country:US
Mailing Address - Phone:651-746-4412
Mailing Address - Fax:651-647-1647
Practice Address - Street 1:821 RAYMOND AVE STE 230
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1503
Practice Address - Country:US
Practice Address - Phone:651-746-4412
Practice Address - Fax:651-647-1647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty