05D0969190 CLIA NUMBER - ROBERT DEBRUIN MD

Laboratory Demographics

  • CLIA Code: 05D0969190
  • Facility Name: ROBERT DEBRUIN MD
  • Facility Address: 1600 CREEKSIDE DR STE 3800
    FOLSOM, CA
    ZIP 95630
  • Facility Phone: 916 984-7830
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ROBERT J. DEBRUIN, MD
  • NPI Number: 1073507786
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0969190
LAB Type Physician Office
Facility Name ROBERT DEBRUIN MD
Street 1600 CREEKSIDE DR STE 3800
City FOLSOM
State CA
ZIP 95630
Phone 916 984-7830
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 1/6/2024
Certificate Expiration Date 1/5/2026
Facility Type Physician Office
Lab Director ROBERT J. DEBRUIN, MD

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This page was last updated on: 9/29/2025