MEDICARE: COCINA RX INCORPORATED

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1902795412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COCINA RX INCORPORATED

Provider Business Mailing Address
First Line	:	3331 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4038
Country	:	US
Telephone Number	:	708-655-5061
Fax Number	:

Provider Business Practice Location Address
First Line	:	3331 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4038
Country	:	US
Telephone Number	:	708-655-5061
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SANDRA AVITIA
Credential	:	RD
Telephone Number	:	708-655-5061

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	07/24/2025

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Directions to “COCINA RX INCORPORATED ” Practice Location

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