Provider Demographics
NPI:1902795412
Name:COCINA RX
Entity type:Organization
Organization Name:COCINA RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVITIA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:708-655-5061
Mailing Address - Street 1:3331 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4038
Mailing Address - Country:US
Mailing Address - Phone:708-655-5061
Mailing Address - Fax:
Practice Address - Street 1:3331 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4038
Practice Address - Country:US
Practice Address - Phone:708-655-5061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COCINA RX
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty