Individual provider Active NPI

Marina Evie Coskinas, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Riverside, CA
National Provider Identifier
1407682875
Registry record updated Sep 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95031706 Issued in CA
Practice address
5900 Brockton Ave
Riverside, CA 92506-1862
Phone
(951) 900-7681
NPI assigned
Sep 11, 2024
Last updated
Sep 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95031706 CA Primary

Addresses

Primary practice location

5900 Brockton Ave
Riverside, CA 92506-1862

Mailing address

31103 Rancho Viejo Rd Ste D3319
San Juan Capistrano, CA 92675-1759

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241024001475 CA Practitioner - Nurse Practitioner 1658804018 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment
Group practices
Evagelos Coskinas MD a Medical CorporationGroup PAC ID 6103357439, 4 clinicians

Practice addresses (Care Compare)

5900 Brockton Ave
Riverside, CA 92506-1862
Phone (800) 992-0901

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95031706CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Evagelos Coskinas MD a Medical Corporation CurrentSince Sep 1, 2024 Accepting new patients

Locations

301 Victoria St
Costa Mesa, CA 92627
Phone (949) 207-3457

1100 W Stewart Dr
Orange, CA 92868
Phone (714) 532-8620

5900 Brockton Ave
Riverside, CA 92506
Phone (800) 992-0901

31103 Rancho Viejo Rd
Ste D
San Juan Capistrano, CA 92675

31103 Rancho Viejo Rd
Ste D3319
San Juan Capistrano, CA 92675
Phone (949) 500-5108

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1407682875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31103 RANCHO VIEJO RD STE D3319",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 BROCKTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925061862",
            "telephone_number": "951-900-7681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSKINAS",
        "first_name": "MARINA",
        "middle_name": "EVIE",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-11",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95031706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.