MEDICARE: DOMONIC DUNLAP

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1891164711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMONIC DUNLAP

Provider Business Mailing Address
First Line	:	8844 COUNTRY SCENE WAY APT 203
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5558
Country	:	US
Telephone Number	:	323-542-7239
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5340
Country	:	US
Telephone Number	:	323-542-7239
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2015
Last Update Date	:	04/28/2017

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Directions to “ DOMONIC DUNLAP ” Practice Location

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