JACQUELYN L. VANDER WALL M.D. – NPI #1699807792
Internal Medicine

An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital.

Health Care Provider Taxonomy Code for Internal Medicine

JACQUELYN VANDER WALL is a physician located in LOS ALAMITOS, CA. NPPES has assigned the NPI number 1699807792 to JACQUELYN VANDER WALL on March 12, 2007. It is a Type-1 NPI, indicating this NPI number is associated with an individual. The primary taxonomy selected by this provider is 207RG0300X from the Health Care Provider Taxonomy code set, which is classified as Internal Medicine, specializing in Geriatric Medicine

The NPI profile was last updated on Nov 30, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for JACQUELYN VANDER WALL below.

NPI Profile for
JACQUELYN L. VANDER WALL

NPI Number
1699807792
Enumeration Date

(more than 19 years ago)
Entity Type
Type-1  Individual (Female)
Legal Name
JACQUELYN L. VANDER WALL
Credentials
M.D.
Primary location
3460 KATELLA AVE
LOS ALAMITOS, CA 90720-2334
Phone: (702) 579-3203 Fax:
1 Other location(s):
11 Technology Dr
Irvine, CA 92618-2302
Phone: (949) 923-3250
Fax: (855) 812-5865
Mailing address
PO BOX 35380
LAS VEGAS, NV 89133-5380
Phone: (702) 579-3203 Fax:
Sole Proprietor
No
Updated
Certification Date
Nov 30, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for JACQUELYN VANDER WALL

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidCA00G65045G
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207RG0300X
- Internal Medicine / Geriatric Medicine (Primary)		 CA G065045

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.

Additional Information

Education
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SCHOOL OF MEDICINE - Graduated 1987
Offers Telehealth Services
Yes - Telehealth services allows you to talk to your health care provider using audio/video communications, such as Zoom, without actually going in to the doctor's office
Accepts Medicare
This provider accepts Medicare-approved amount as payment in full. The Medicare-approved amount is the total the provider can be paid. When a provider accepts the Medicare-approved amount as payment, you won't be billed for more than the Medicare deductible & coinsureance.
Medicare Ordering & Referring
Provider can:
  • Refer to Part B
  • Order Durable Medical Equipment
  • Refer to Home Health Agency
  • Order Power Mobility Devices
Affiliations
JACQUELYN VANDER WALL is affiliated with the following medical group(s):
  • HOSPITAL
    • LONG BEACH MEMORIAL MEDICAL CENTER
      2801 ATLANTIC AVE
      LONG BEACH, CA 90806
  • HOME HEALTH AGENCY
    • AMICABLE HOMECARE, INC
      13819 SAN ANTONIO DRIVE
      NORWALK, CA 90650
  • HOSPICE
    • INFINITE HOSPICE CARE, INC
      16200 VENTURA BLVD SUITE 211
      ENCINO, CA 91436

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