Organization Name: | JACQUELYN VANDER WALL MD. INC |
NPI Number: | 1386724375 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACQUELYN LEE VANDER WALL (MD) |
Mailing Address: | 11 Technology Dr Irvine |
State: | CA US |
Postal Code: | 926182302 |
Phone Number: | 9499233250 |
Fax Number: | 8558125865 |
NPI Enumeration Date: | 10/16/2006 |
NPI Last Update Date: | 04/26/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | G065045 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy 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. |