JACQUELYN VANDER WALL MD. INC NPI 1386724375

NPI Information

JACQUELYN VANDER WALL MD. INC is a specialist in Irvine, CA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. JACQUELYN VANDER WALL MD. INC NPI is 1386724375. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Optumcare Medical Group.

The provider's business location address is:

11 TECHNOLOGY DR
IRVINE, CA
ZIP 92618-302
Phone: (949) 923-3250
Fax: (855) 812-5865

The provider's authorized official is Jacquelyn Lee Vander Wall .
The authorized official title is Md and has the following contact phone number (562) 594-6599.

The CLIA number assigned to this NPI record is 05D0579395 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/16/2006 and was last updated on 4/26/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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