Jacquelyn Vander Wall MD. Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

G065045 Issued in CA

Legal business name

JACQUELYN VANDER WALL MD. INC

Doing business as

OptumCare Medical Group

Practice address

11 Technology Dr
Irvine, CA 92618-2302

Phone

(949) 923-3250

Fax

(855) 812-5865

NPI assigned

Oct 16, 2006

Organization subpart

No

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

Authorized official

Name

Jacquelyn Lee Vander Wall, M.D.

Title

MD

Phone

(562) 594-6599

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• OptumCare Medical Group Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Julia S. Gonzales, NP

  • Nurse Practitioner
  • Harbor City, CA
  • NPI 1649471533
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461628800000",
    "number": "1386724375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3460 KATELLA AVE",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907202334",
            "telephone_number": "562-594-6599",
            "fax_number": "562-598-7116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 TECHNOLOGY DR",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926182302",
            "telephone_number": "949-923-3250",
            "fax_number": "855-812-5865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACQUELYN VANDER WALL MD. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2016-04-26",
        "status": "A",
        "authorized_official_last_name": "VANDER WALL",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "562-594-6599",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G065045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G65045G",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "CB252872",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OptumCare Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Janay Jacobs
• Janet Jacobs, LMFT
• Maxwell Jacobs
• Michelle Erin Jacobs, IBCLC
• Nicholas David Jacobson, MD
• Mark Jacques
• Priscilla Jadallah, LMFT
• Jade Phoenix Aesthetic Medicine, PC
• Amir Jadidian, MD
• Lucie McCrea Jadow

• Specialist in Irvine, CA
• Providers in Irvine, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2016; 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.