Debruin Medical Center a.P.C.
Organization Active NPI Family Medicine Physician · Orangevale, CA
NPI 1104095975 · NPPES record last updated Feb 26, 2008
Key facts
- NPI
- 1104095975
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 20A5579 (CA)
- Legal business name
- DEBRUIN MEDICAL CENTER A.P.C.
- Practice address
- 9352 Madison Ave
Ste. One
Orangevale, CA 95662-4968 - Phone
- (916) 989-2929
- Fax
- (916) 989-0322
- NPI assigned
- Feb 26, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Mark Ike Debruin, D.O.
- Title
- Owner
- Phone
- (916) 989-2929
Practitioners 1
-
Mark Ike Debruin, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081209000025 | CA | Part B Supplier - Clinic/Group Practice | 8022179142 |
Receives reassigned benefits from 1 practitioner Practice locations: Orangevale, CA |
National Provider Directory
Locations
9352 Madison Ave
Ste 1
Orangevale, CA 95662
Phone (916) 989-2929
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 20A5579 | CA | Yes |
Addresses
Primary practice location
9352 Madison Ave
Ste. One
Orangevale, CA 95662-4968
Mailing address
9352 Madison Ave
Ste. One
Orangevale, CA 95662-4968
Phone (916) 989-2929
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00AX55790 | Medicaid | CA |
Other providers in Orangevale, CA
- Ondrea Lynn Cumbra
- Emese Elisabeth Dabic
- Darrell Broaddus Psychological Services PC
- Kristine Davenport
- Gasem Dawara
- Debruin Research, Inc
- Mark Ike Debruin
- Danielle Rayleen Deltoro
- Neha Devi
- Eugene Dey
All providers in Orangevale, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.