Provider Demographics
NPI:1619701638
Name:KRISTINA COOKE NUTRITION
Entity type:Organization
Organization Name:KRISTINA COOKE NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:424-348-0475
Mailing Address - Street 1:19908 MILDRED AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1124
Mailing Address - Country:US
Mailing Address - Phone:310-406-6350
Mailing Address - Fax:
Practice Address - Street 1:500 AVENUE G APT 10
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-6001
Practice Address - Country:US
Practice Address - Phone:310-406-6350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty