Provider Demographics
NPI:1649722760
Name:BASCO, CLAIRE
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:BASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PLEASANT GROVE BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6156
Mailing Address - Country:US
Mailing Address - Phone:916-784-7700
Mailing Address - Fax:916-784-2252
Practice Address - Street 1:701 PLEASANT GROVE BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6156
Practice Address - Country:US
Practice Address - Phone:916-784-7700
Practice Address - Fax:916-784-2252
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005131363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01-0976500OtherTIN