Healthcare Provider Details

I. General information

NPI: 1700307022
Provider Name (Legal Business Name): ANGIE CRISTINA MORILLAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6013 KILLARNEY LN S
EDINA MN
55436-1811
US

IV. Provider business mailing address

515 DELAWARE ST SE RM 6-284B
MINNEAPOLIS MN
55455-0357
US

V. Phone/Fax

Practice location:
  • Phone: 614-817-7007
  • Fax:
Mailing address:
  • Phone: 612-626-3478
  • Fax: 612-301-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number57.029154
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number528657
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: