Organization
DEBRUIN MEDICAL CENTER A.P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK IKE DEBRUIN D.O. (OWNER)
(916) 989-2929
Entity
Organization
Contact information
Practice address
9352 MADISON AVE, STE. ONE, ORANGEVALE, CA 95662-4968
(916) 989-2929
(916) 989-0322
Mailing address
9352 MADISON AVE, STE. ONE, ORANGEVALE, CA 95662-4968
(916) 989-2929
(916) 989-0322
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A5579
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX55790
—
CA
Enumeration date
02/26/2008
Last updated
02/26/2008
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