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Jacquelyn Vander Wall Md. Inc
Specialist in Irvine, California
NPI 1386724375

Jacquelyn Vander Wall Md. Inc is a Specialist based in Los Alamitos, CA. Jacquelyn Vander Wall Md. Inc practices in Irvine, CA. The NPI Number for Jacquelyn Vander Wall Md. Inc is 1386724375 and holds a License No. G065045 (California).

The current practice location address for Jacquelyn Vander Wall Md. Inc is 11 Technology Dr, Irvine, CA and can be reached out via phone at 949-923-3250 and via fax at 855-812-5865.

Location: 11 Technology Dr, Irvine, CA, 90720-2334
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1386724375
Provider Name
Jacquelyn Vander Wall Md. Inc
Credential
Provider Entity Type
Organization
Address
11 Technology Dr, Irvine, CA, 90720-2334
Phone Number
949-923-3250
Fax Number
855-812-5865
Provider Enumeration Date
10/16/2006
Last Update Date
02/15/2025
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Provider's Legacy Identifiers
Identifier Type State Issuer
00G65045G 05 CA
CB252872 01 CA MEDICARE
institution
Provider Business Practice Location Address Details
Address
11 Technology Dr
City
Irvine
State
California
Zip
92618-2302
Phone Number
949-923-3250
Fax Number
855-812-5865
person
Provider Business Mailing Address Details
Address
11 Technology Dr
City
Irvine
State
California
Zip
92618-2302
Phone Number
949-923-3250
Fax Number
855-812-5865
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
G065045 (California)
Definition
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.
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