Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. David Mendiola Basco III, NURSEPRACTITIONER

Individual provider Registered Nurse · NPI 1790413920

Mr. David Mendiola Basco III, NURSEPRACTITIONER is a Nurse Practitioner in Sacramento, California. Qualified in 2022, 4 years ago. Practices with Active Life Wound Clinic a Professional Nursing Corporation, a 7-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in California.

Years since qualifying
4
Licensed in
CA
In the registry since
2022
Specialties on file
3
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Practice location Address checks out

3301 C St Ste 1500
Sacramento, CA 95816-3371
Phone: (916) 734-7463
Fax: (916) 734-6493
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 729 Sunrise Ave Ste 602, Roseville, CA 95661-4542 — (916) 953-7571
  • 650 Howe Ave Ste 600, Sacramento, CA 95825-4797 — (916) 953-7571

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 95022230 (CA)
Registered Nurse Taxonomy 163W00000X · Licence 802458 (CA)
Nurse Practitioner Taxonomy 363L00000X · Licence F07221391 (CA)

Record details

NPI number1790413920
Entity typeIndividual (Type 1)
GenderMale
Credentials NURSEPRACTITIONER
Sole proprietorNo
NPI enumeratedAugust 15, 2022
Last updated in NPPESMay 24, 2023
Certification dateMay 16, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Active Life Wound Clinic A Professional Nursing Corporation — 7 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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