JACQUELYN VANDER WALL MD. INC NPI 1386724375

NPI Information

  • NPI: 1386724375
  • Provider Name: JACQUELYN VANDER WALL MD. INC
  • Classification: Specialist - 174400000X
  • Entity Type: Organization
  • Doing Business As: OPTUMCARE MEDICAL GROUP
  • CLIA Number: 05D0579395
  • Address: 11 TECHNOLOGY DR
    IRVINE, CA
    ZIP 92618
  • Phone: (949) 923-3250

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NPI Details

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistG065045CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100G65045GMEDICAIDCALIFORNIA
2CB252872OTHERCALIFORNIAMEDICARE
3W18164MEDICARE ID-TYPE UNSPECIFIEDCALIFORNIAGROUP MEDICARE NUMBER
4E80521MEDICARE UPINCALIFORNIA
5WG65045GMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIAINDIVIDUAL MEDICARE NUMBE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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