MEDICARE: INTERNATIONAL MEDICAL ALLIANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	G61359	CA
2	261Q00000X	Clinic/Center	11845	NV

General Provider Information

NPI Number	:	1689883654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL MEDICAL ALLIANCE

Provider Business Mailing Address
First Line	:	PO BOX 15546
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95852-0546
Country	:	US
Telephone Number	:	916-967-9300
Fax Number	:	916-967-9301

Provider Business Practice Location Address
First Line	:	8653 DEERING BAY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-1757
Country	:	US
Telephone Number	:	916-967-9300
Fax Number	:	916-967-9301

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DANIEL B DUNLEVY
Credential	:	MD
Telephone Number	:	916-967-9300

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	01/28/2010

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Directions to “INTERNATIONAL MEDICAL ALLIANCE ” Practice Location

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