Jacqueline Parke, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY24269 Issued in CA

Practice address

1370 Brea Blvd
Suite 210
Fullerton, CA 92835-4125

Phone

(714) 451-6327

NPI assigned

Jun 20, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Jacqueline Moonilal Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398988800000",
    "number": "1245435932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1370 BREA BLVD",
            "address_2": "SUITE 210",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928354125",
            "telephone_number": "714-451-6327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 BREA BLVD",
            "address_2": "SUITE 210",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928354125",
            "telephone_number": "714-451-6327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKE",
        "first_name": "JACQUELINE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-20",
        "last_updated": "2014-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY24269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "MOONILAL",
            "prefix": "DR.",
            "credential": "PSY.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sungjin James Park, D.M.D.
• Susan Hahn Park, MA, CCC-SLP
• Yong Joon Caleb Park
• Yoon Su Park, BCBA
• Young Lim Park, L.AC.
• John F. Parker Jr., M.D.
• Scott Forrest Parker, PT
• Parklee DDS Inc.
• Savannah Parks
• Ashley Nicole Parra Calderon

• Clinical Psychologist in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.