Provider Demographics
NPI:1437317773
Name:PASKO, JACLYN KEEGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:KEEGAN
Last Name:PASKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 SIERRA GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2912
Mailing Address - Country:US
Mailing Address - Phone:916-784-4190
Mailing Address - Fax:
Practice Address - Street 1:1840 SIERRA GARDENS DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2912
Practice Address - Country:US
Practice Address - Phone:916-784-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2011-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA108904208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program