MEDICARE: LA COCINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1811554272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA COCINA

Provider Business Mailing Address
First Line	:	409 MASON CT UNIT 123
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4465
Country	:	US
Telephone Number	:	970-232-0740
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 MASON CT UNIT 123
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4465
Country	:	US
Telephone Number	:	970-232-0740
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ANNA GOMEZ
Credential	:
Telephone Number	:	970-818-8914

Provider Enumeration Date	:	05/21/2019
Last Update Date	:	03/13/2026

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Directions to “LA COCINA ” Practice Location

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