| Debruin Medical Center A.p.c. | |
|
9352 Madison Ave Ste. One Orangevale CA 95662-4968 | |
| (916) 989-2929 | |
| (916) 989-0322 |
| Full Name | Debruin Medical Center A.p.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 9352 Madison Ave, Orangevale, California |
| Authorized Official Name and Position | Mark Ike Debruin (OWNER) |
| Authorized Official Contact | 9169892929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Debruin Medical Center A.p.c. 9352 Madison Ave Ste. One Orangevale CA 95662-4968 Ph: (916) 989-2929 | Debruin Medical Center A.p.c. 9352 Madison Ave Ste. One Orangevale CA 95662-4968 Ph: (916) 989-2929 |
| NPI Number | 1104095975 |
|---|---|
| Provider Enumeration Date | 02/26/2008 |
| Last Update Date | 02/26/2008 |
| Medicare PECOS PAC ID | 8022179142 |
|---|---|
| Medicare Enrollment ID | O20081209000025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104095975 | NPI | - | NPPES |
| 00AX55790 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A5579 (California) | Primary |
| Provider Name | Mark I Debruin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154327518 PECOS PAC ID: 2567523681 Enrollment ID: I20081212000345 |
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