Provider Demographics
NPI:1790413920
Name:BASCO, DAVID MENDIOLA III (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MENDIOLA
Last Name:BASCO
Suffix:III
Gender:M
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:4800 Y STREET
Mailing Address - Street 2:SUITE 3740
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-734-3658
Mailing Address - Fax:916-703-5368
Practice Address - Street 1:3301 C ST STE 1500
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3371
Practice Address - Country:US
Practice Address - Phone:916-734-7463
Practice Address - Fax:916-734-6493
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2023-05-24
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Provider Licenses
StateLicense IDTaxonomies
CA802458163W00000X
CAF07221391363L00000X
CA95022230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner