Provider Demographics
NPI:1053029918
Name:EVAGELOS COSKINAS MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:EVAGELOS COSKINAS MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAGELOS
Authorized Official - Middle Name:
Authorized Official - Last Name:COSKINAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-500-5108
Mailing Address - Street 1:31103 RANCHO VIEJO RD STE D3319
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1759
Mailing Address - Country:US
Mailing Address - Phone:951-244-4147
Mailing Address - Fax:951-244-0747
Practice Address - Street 1:301 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1995
Practice Address - Country:US
Practice Address - Phone:949-500-5108
Practice Address - Fax:951-244-0747
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVAGELOS COSKINAS MD A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-09
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty